Pre-visit telephone questionnaire template
Below is a template for a pre-visit questionnaire that can be done over the phone. Whilst all LEAD home visit should bepreced with some background research, some organisations and Retrofit Advisor may prefer to capture contained in this form during the visit itself.
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Personal Details |
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Your name |
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Date |
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Address |
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Street |
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Town |
Postcode |
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Local Authority: |
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Tenure |
Owner occupied / Private rent / Social rent / Co-op / Shared ownership
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Occupants |
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Adults |
How many? |
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Under 5s |
How many? |
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5-17 years old |
How many? |
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Over 65s |
How many? |
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Pets |
Anything that would affect energy use? Windows left open for cats, etc. |
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Any health conditions to note |
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OPTIONAL List any health conditions that could be caused or affected by living in a cold or damp home. |
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Other building works planned |
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Yes / No |
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Notes: Include any plans for loft conversion, extension, layout changes or any major maintenance now or in the future. |
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Expected start date for retrofit works |
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X months or years |
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Notes: Include notes on specific deadlines here |
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Priorities |
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Leave in any of these that are a priority. Save carbon Save money Improve comfort Improve indoor air quality General modernisation and repair Improve health |
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Top three in order starting with the top priority: |
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Any key features you have a preference for of or materials/measures to avoid |
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Notes: Describe here |
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Do you plan to do the work...all in one go or in phases? |
All in one go or in phases |
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Are you willing to do some of the work yourself? |
Yes / No |
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Notes: Your thoughts about how you would get the work done, including any help you might need.
If you are willing to do some of the work, how much? |
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Budget in mind? |
Yes or I will work out a budget after understanding what's possible |
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Notes: You don’t have to disclose an amount at this point, but it’s useful for us to know - Write down your budget here and how you have approached putting it together
How are you funding the works? E.g. mortgage, savings, other loans, grants - this can have a bearing on timescales, products/systems and certifications |
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House type |
Mid-terrace / Semi-detached or end terrace / Detached / Flat (conversion) / Flat (purpose built) |
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Any peculiarities? |
Note anything that stands out |
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Number of bedrooms |
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Location |
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Orientation |
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Elevation and/or any other relevant location specifics |
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Floors |
How many floors and what are they constructed from.
Are you interested in any related measures in particular? |
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Walls |
What are the external walls constructed from and do they have a cavity? Are they the same all around?
Are you interested in any related measures in particular? |
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Roof |
What sort of roof do you have? Is the roof or loft insulated?
Are you interested in any related measures in particular? |
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Windows and doors |
What sort of windows do you have? Are they the same all around?
What are your external doors made from?
Are you interested in any related measures in particular? |
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Rainwater and drainage goods |
Do you have any issues with your gutters or drainage issues? |
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Construction ventilation |
Aside from opening windows and any fans are you aware of any other ventilation? |
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What has already been done, by you or previous residents? |
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List any energy efficiency, major construction work, extensions and layout changes. |
Status, severity of any current or potential structural issues in your home?
Describe any damp, condensation or mould in your home, including any evidence of water ingress or leaks.
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Your space heating is currently provided by... |
Describe your system |
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...which you control by |
Describe what you have and use such as a programmer timer, thermostatic radiator valves, zoning or intelligent thermostat |
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How is the heating system used? |
Describe thermostat settings, heating cycles etc. |
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Utility connections |
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Do you have a mains electricity connection, mains gas connection, mains water connection, mains sewer connection? |
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Exact year built |
Year |
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In a conservation area |
Yes / No |
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Listed status |
Type |
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Notes: Any other historic significance? |
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History of flooding? |
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Yes / No |
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