Assessment and Maintenance Tool
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Other
Country
Landline Telephone
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Area Code
Phone Number
Mobile Telephone
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Area Code
Phone Number
E-mail Address
Property Details
Property Type
Detached House
Semi-detached House
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Flat
Detached Bungalow
Semi-Detached Bunglow
Terraced Bungalow
Other
Property Status
Owned
Socially Rented
Privately Rented
Other
Year Constructed
Year Purchased
Roof Pitch
Roof Material
Windows and Doors
Single Glazing
Double Glazing
Tripple Glazing
Traditional Timber Doors
UPVC Doors
Compoosite Doors
Aluminium Doors
Other
Insulation
Cavity Wall
Loft
External
Internal
Floor
Chimney & Flue & Safety
Additional Description
Chimney & Flue
Construction
Masonry
Masonry Twin Wall
Twin Wall
Steel Lined
Clay / Concrete Lined
Unlined
Other
Shape
Round
Square
Rectangular
Size
100mm
125mm
150mm
175mm
200mm
Other
Condition
Good
Fair
Poor
Dangerous
Horizontal Flue Exit
<= 150mm
> 150mm
Not applicable
Flue Length
metres
Chimney Termination Height
metres
Cowl
type
Additional Descriptive Information
Any symptons of down draught?
Yes
No
Unknown
Other
Down Draught Symptons
Insulated
Yes
No
Unknown
Other
Insulation Material
Carbon Monoxide / Fire / Ventilation
Ventilation
Suitable Ventilation Installed
Unsuitable Ventilation Installed
No Ventilation Installed
Ventilation Not Required
Other
Carbon Monoxide
CO Alarm Fitted
CO Alarm Not Fitted
CO Alarm Fitted Incorrectly
CO Second Alarm Required
CO Third Alarm Required
Other
Fire Alarm
Smoke Alarm Fitted
Smoke Alarm Not Fitted
Second Smoke Alarm Required
Third Smoke Alarm Required
Other
Is extractor fitted in room of stove?
Yes
No
Stove / Fire
Type of Fire
Open Fire
Freestanding Stove
Inset Stove
Cassette Stove
Other
Fuel
Wood
Multi-Fuel
Pellet
Other
Manufacturer
Model
Installed by
Year of Install
Flue Outlet Size
mm
Identification Plate Fitted
Yes
No
Location of Plate
Location of Stove
Boiler Fitted
Yes
No
Boiler type
Stove Size
KW
Room size Stove Located
LxWxH (m)
Room Volume
m³
Calculated Stove Size
KW
Hearth
Drawing
Hearth Type
Constructional
Superimposed 50mm
Superimposed 12mm
None Present
Combustability
Non Combustable
Combustable
Investigation Required
Description
Heating System
Boiler Type
Stove
Internal Combi
External Combi
Internal Combi
External Combi
Solid Fuel Back Boiler
Regular tank in loft
Open Fire
Other
System solar and cylinder
Fuel
Oil
LPG
Natural Gas
Solid Fuel
Wood
Pellet
Wet Electric
Storage Heaters
Solar
Wind
Not present
Other
Current Hot Water
Oil
LPG
Natural Gas
Solid Fuel
Wood
Pellet
Wet Electric
Solar
Wind
Not present
Other
Radiators installed
Yes
No
Number of Radiators
Circuit
Single
Dual
Uncertain
Other
Hot Water Flow
Gravity
Combi
Pressurised Vented
Pressurised Unvented
Other
Description of Hot Water
Thermostat Fitted
Yes
No
Wired or Wireless
Wired
Wireless
Make
Model
Programmer Fitted
Yes
No
Wired or Wireless
Wired
Wireless
Make
Model
Fuel Storage
Coal Bunker Outside
Wood Storage Shed Outside
Unsheltered Outside
Inside garage / shed
Other
Fuel Storage Location
Sheltered in Prevailing Wind
Sheltered out of Prevailing Wind
Other
Fuel Storage Description
Chimney Last Swept
MM/YYYY
Chimney Swept By
Work Carried Out Today
Chimney
Chimney Swept
Yes
No
Other
Description of work on Chimney
Chimney Swept Description
Smoke Test
1
2
3
Smoke Test Description
Stove
Stove Serviced
Yes
No
Description of work on Stove
Fire Cement Applied
Yes
No
Fire Cement Description
Fire Rope Applied
Yes
No
Fire Rope Description
Fire Paint Applied
Yes
No
Fire Paint Description
Stove Boiler
Description of work on Boiler
Suggested Future Work
Should be Empty: