Pre Survey Heat Pump Questionnaire

This short questionnaire will allow us to asses the suitability of your property for a heat pump. Please complete this enquiry form to the best of your knowledge, but do not worry if you are not sure of any of the answers. Once you have completed the questionnaire one of our Heat Pump team will be in contact with you to discuss your requirements.

Name

Mobile Number

Address

Postcode

When are you looking to have the Air Source Heat Pump system installed?

0-1 Month 1-2 Months 3-6 Months 6+ Months

Are you the homeowner?

Is it main home or holiday home?

Number of occupants?

Property type?

Detached Semi-Detached Terraced Bungalow End Terrace Care Home Annexe Other

Approximate year of construction?

Number of floors?

Number of bedrooms?

Number of bathrooms?

Wall construction?

Solid Stone 12 inch (300mm) Solid Stone 18 inch (450mm) Solid Stone 24 inch (600mm) Open Cavity brick and block Insulated Cavity brick and block Timber framed brick outer Timber framed tiled outer Timber framed wood paneled outer Solid Stone (other, variable or unknown thickness) Partly cavity, partly solid-wall construction I don't know

Double glazing?

Roof insulation?

Yes Loft insulation complete to 270mm or greater Loft insulation complete to 100mm - 269mm only Loft insulation partial coverage only No

Is the floor of the loft boarded?

Floor type?

Solid no insulation Solid 25mm insulated Solid 50mm insulated Solid 75mm insulated Solid 100mm insulated Suspended not insulated Suspended 25mm insulated Suspended 50mm insulated Suspended 75mm insulated Suspended 100mm insulated Mixture of suspended timber floors and some solid floors I don't know

Do you have a current EPC issued within the past 2 years?

Is the property listed or in a conservation area?

Are you planning to extend in the near future?

Current heating system?

Sealed system pressurised no tanks in loft Open vented with tanks in the loft Unknown type of gas or oil central heating with no tanks in the loft Unknown type of gas or oil central heating with tank in the loft Electric storage heaters only Gas fires only Log burner or solid fuel burning system only

Boiler location?

Kitchen Utility Room Garage Hall Bathroom Porch Loft Landing Bedroom Basement Outside/Garden No Boiler

Boiler type?

Combination Boiler Regular Boiler System Boiler Aga Solid fuel Electric boiler Heat pump Ground source Biomass None (no boiler present)

Cylinder - Pressurised / Open vent?

Vented cylinder with tanks in loft Unvented cylinder with no tanks in loft Combination boiler Not applicable (no cylinder or combi boiler)

Roof tanks?

Yes No Don't know

Number of radiators?

Underfloor heating?

Pipework to radiators

15mm copper tube (two pipes) 15mm copper tube (one pipe) 10mm copper tube (two pipes) Plastic

Do you have solar panels fitted?