Gas Boiler Tech Survey

First Name

Last Name

Phone *

Email *

Address

Street Address

City

Postal Code

For any survey issues please call the surveyor below

Surveyor Name

Photos of outside of property

Is asbestos suspected in present materials?

If Yes, Please detail

Electric Meter Type

Existing Heating

Stopcock Location

Photo of Stopcock

photos of Existing Heating (Include Databadges)

Location/GPS Photo

Gas Boiler Details

Existing Gas and Boiler Position

New Gas Boiler Position

Horizontal Flue or Vertical Flue

Gas Boiler Psition Photos

Gas Run Details

Is there Earth Bonding at the Gas Meter

Would you like to provide further details/photos/video of gas run route?

notes

Additional photos if applicable

Video if applicable

Confirmed Clearances OK

Check the water pressure of the house

Water Pressure Photo

Plume Management Kit required

N/A

Yes

Position Agreed with Customer

Condensate Termination Gravity or Pumped

Condensate Termination Photos

Amount of Pipe Needed (15mm)In Meters

Amount of Pipe Needed (22mm)In Meters

Amount of Pipe Needed (28mm)In Meters

Amount of Talon Trunking Required (15mm) Lengths

Amount of Talon Trunking Required (22mm) Lengths

Is there power at the proposed site of the new boiler

What size fuse on the main board

Type of Electrical Circuit in house

Any faults on electrical circuit

Notes of Fault

Photos of elecrical test

Cylinder Details

Cylinder Position

Cylinder position photos

A/C Depth

A/C Width

A/C Height

A/C Door Height

A/C Door Width

Checked Boiler Clearances

Existing Water Supply

Cylinder Position Agreed with Customer

PRV Termination Description

PRV Termination Description (copy)

Is the house in a hard water area

N/A

Yes

Is there limescale filter in place

N/A

Yes

Radiator Details

How many rooms require radiators?

How many radiators require TRV's and what size pipe work

Radiator Notes

Radiator Additional Photos

Room 1

Room 1 Radiator Location(s)Photo(Include all Radiators)

Room 2

Room 2 Radiator Location(s)Photo(Include all Radiators)

Room 3

Room 3 Radiator Location(s)Photo(Include all Radiators)

Room 4

Room 4 Radiator Location(s)Photo(Include all Radiators)

Room 5

Room 5 Radiator Location(s)Photo(Include all Radiators)

Room 6

Room 6 Radiator Location(s)Photo(Include all Radiators)

Room 7

Room 7 Radiator Location(s)Photo(Include all Radiators)

Room 8

Room 8 Radiator Location(s)Photo(Include all Radiators)

Room 9

Room 9 Radiator Location(s)Photo(Include all Radiators)

Room 10

Room 10 Radiator Location(s)Photo(Include all Radiators)

Room 11

Room 11 Radiator Location(s)Photo(Include all Radiators)

Additional Notes/Photos required

Additional Photos

Additional Notes

Sign Off

Customer Pre-Requirements?(E.g. Move Furniture)

Customer Pre-Requirement Description

Installation Notes

Surveyors Name

Date/Time

Surveyors Signature

Clear

Customers Declaration

Customers Name

Following our technical survey today, would you like a follow-up call from the office to discuss any of the findings, prior to us producing a design/installation proposal?

Customer Signature

Clear

I, the surveyor,find

Additional Photos and Notes

Extra Photos

Customer Notes