Heat Pump Pre Survey Questionnaire

Name

Surname

Email address

Mobile number

Address

Postcode

Town or city

When are you looking to have the Air Source Heat Pump system installed?
Please select0 to 1 month1-3 months3-6 monthsI'm not sure

Are you the homeowner?
Please selectYesNo

Is it main home or holiday home?
Please selectMain homeHoliday home lived in more than 50% of the year

Number of occupants?

Property type?
Please selectTerracedSemi-detachedDetachedBungalowEnd terraceCare homeAnnexeOther

Approximate year of construction?

Number of floors?

Number of bedrooms?

Number of bathrooms?

Wall construction?
Using the dropdown below please describe your wall construction
Please selectSolid stone 12 inch (300mm)Solid stone 18 inch (450mm)Solid stone 24 inch (600mm)Open cavity brick and blockInsulated cavity brick and blockOpen cavity brick and brickInsulated cavity brick and brickTimber framed brick outerTimber framed tiled outerTimber framed wood paneled outerSolid Stone (other, variable or unknown thickness)Partly cavity, partly solid-wall constructionI don't know

Double glazing?
Please selectYesPartial (more than 50% of windows but not all)Partial (some but less than 50% of windows)No

Roof insulation?
Please selectYesLoft insulation complete to 270mm or greaterLoft insulation complete 100mm to 269mm onlyLoft insulation partial coverage onlyNo

Is the floor of the loft boarded?
Please selectNoPartial floor-boarding to central part of loft onlyLoft floor fully boarded

Floor type?
Using the dropdown below please describe your floor type
Please selectSolid no insulationSolid 25mm insulatedSolid 50mm insulatedSolid 75mm insulatedSolid 100mm insulatedSuspended no insulatedSuspended 25mm insulatedSuspended 50mm insulatedSuspended 75mm insulatedSuspended 100mm insulatedMixture of suspended timber floors and some solid floorsI don't know

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

Is the property listed or in a conservation area?
Please selectYesNo

Are you planning to extend in the near future?
Please selectYesNo

Current heating system?
Please selectSealed system pressurised no tanks in the loftOpen vented with tanks in the loftUnknown type of gas or oil central heating with no tanks in the loftUnknown type of gas or oil central heating with tanks in the loftElectric storage heaters onlyGas fires onlyLog burner or solid fuel burning system only

Boiler location?
Please selectKitchenUtility roomGarageHallBathroomPorchLoftLandingBedroomBasementOutside/GardenNo boiler

Boiler type?
Please selectCombination boilerRegular boilerSystem boilerAgaSolid fuelElectric boilerHeat pumpGround sourceBiomassNone (no boiler present)

Cylinder - Pressurised / Open vent?
Please selectVented cylinder with tanks in the loftUnvented cylinder with no tanks in the loftCombination boilerNot applicable (no cylinder or combi boiler)

Roof tanks?
Please selectYesNoDon't know what a roof tank is

Number of radiators?

Underfloor heating?
Please selectYesPartial (less than 50% of downstairs room coverage)No

Pipework to radiators
Using the dropdown below please describe the pipework to your radiators
Please select15mm copper tube (Two pipes)15mm copper tube (One pipe)10mm copper tube (Two pipes)Plastic

Do you have solar panels fitted?
Please selectYes (solar PV only)Yes (solar thermal only)Yes (both solar PV and solar thermal)No