The Home Energy Survey

The Home Energy Survey:

Every home is different, so by letting us know as much as possible about your home, we can tell you how you can save energy and reduce your fuel bills while helping to save the environment.

Simply fill out this survey by completeing you name and address and clicking the appropriate mark for each of your answers and we will send you a personalised report with recommendations for your home, their cost and details of the savings you could make. We will also include details of any grants which you may be able to claim.

The South West London Energy Efficiency Advice Centre is a not-for-profit organisation working in partnership with your Local Authority and the Energy Saving Trust.

If you have any questions or would simply like more information, please call free on 0800 512 012.

Your Details:

Title:
First Name or Initials:
Surname:
Your Address:
Your Postcode:
Daytime telephone:
e-mail address:

Your Home:

When was your home built?
	Since 1996	1991 - 1995	1982 - 1990
	1981	1977 - 1980	1976
	1966 - 1975	1965	1950 - 1964
	1945 - 1949	1930 - 1944	1919 - 1929
	1900 - 1918	Before 1900

What type of home do you live in?
	Detached	Semi-detached	End terrace
	Mid terrace	Mid terrace with passage	Top floor Flat
	Middle floor Flat	Ground floor Flat

Do you own or rent your home?
	Own or buying on a mortgage	Renting from Council	Renting from Housing Association
	Renting privately	Tied house / other

Does your home have a loft?
	Yes	No

	- If so, do you have a heated room that's in regular use in the loft?
		Yes	No

How many floors does your home have?
(excluding loft rooms or cellars)
	1	2	3
	4	5	More than 5

How many bedrooms does your home have?
	1	2	3
	4	5	6
	More than 6

How many living, dining, study or play rooms does your home have?
(Please use none if your home is a bedsit)
	None	1	2
	3	4	More than 4

Is your building listed or in a conservation area?
	No	Yes, conservation area	Yes, listed

Insulation:

How much loft insulation does your home have?
If this is going to prove difficult to find the answer,please take an educated guess.
	None	25mm (1 inch)	50mm (2 inches)
	75mm (3 inches)	100mm (4 inches)	150mm (6 inches)
	200mm (8 inches)	Don't Know
	No loft

Does your loft have any flooring?:
	Yes	No (or no loft)

What type of outside walls does your home have?
	Solid Brick Walls	Cavity walls - no insulation	Cavity walls - with insulation
	Modern Timber Frame	Mixed cavity & solid	Solid Stone Walls
	Solid Concrete Walls	Other/Don't Know

It's often possible to tell the type of wall from the brick pattern. Left is a typical cavity wall, made up only from 'stretchers'. Right is a typical nine-inch solid wall brick pattern, where 'headers' (the short bricks) are laid crossways to tie the the wall.

What type of windows does your home have?
	All single glazed	Some double or secondary glazed	Most double or secondary glazed
	All double or secondary glazed

Is there any draught proofing on your windows and external doors?
(Assume sealed double glazed windows to be draughtproofed)
	None draught proofed	Some draught proofed	Most draught proofed
	All draught proofed

Your heating system:

What is the main system that you use for heating your home?
	Boiler & Radiators	Warm Air System	Room Heaters (eg gas fires)
	Electric Storage Heaters	Other System

And what fuel does it use?
	Natural (mains) gas	Electricity	Oil
	Bottled Gas	Solid Fuel (Coal, wood or peat)	LPG (bulk)

Do you have a separate fire that you use regularly?
	Yes, electric	Yes, solid fuel	Yes, gas
	No

What type of heating controls do you have on your main heating system?
Please mark all that apply.
	Room thermostat	Yes No
	Timer/Programmer	Yes No
	TRVs (Thermostatic radiator valve)	Yes No
	Storage heater dials	Yes No

How old is this main heating system?
	Under 5 years old	5 to 10 years old	11 to 15 years old
	Over 15 years old

Do you have foil behind any of your radiators?
	None	Yes, some	Yes, all

Do you have a condensing boiler?
If you are not sure, please tick "No". Condensing Boilers are not the same as Combination Boilers (which don't have a hot water tank).
	No	Yes

Your hot water system:

How is your hot water usually provided?
	From Central Heating system (with hot water tank)	Instant Gas or Combi boiler	Instant Electric
	Single Immersion (Economy 7/off-peak)	Single Immersion (on-peak)	Dual Immersion Heater (on & off peak)
	Gas, oil or solid fuel Range (eg AGA)	Back boiler	Don't Know or Other

How would you describe your hot water tank insulation?
	Not applicable (no tank)	No insulation	Solid foam insulation
	Jacket (no gaps around jacket)	Jacket (with gaps around jacket)

If you have a hot water tank, is there insulation on the pipework between it and the boiler?
	Not applicable (no tank)	Yes	No
	Can't see pipes	Don't know

What type of hot water controls do you have ?
Please mark all that apply
	On/off switch	Yes No
	Programmer / timer	Yes No
	Hot water tank thermostat	Yes No

Lighting:

How many of your lights have low energy lightbulbs fitted?
	None	One	Some
	Most	All	Don't know

Grants:

The following questions will be used to help us decide whether or not there may be a grant available to help you install any energy efficiency measures.

Is a member of your household
	aged over 60?	Yes	No
	in receipt of benefits?	Yes	No

How many people live in your home?
	1	2	3
	4	5	More than 5

How many of the people in your home are aged under 16?
	None	1	2
	3	4	5
	More than 5

Data Protection:

The Energy Saving Trust, the data controller, is collecting your data for the purpose of providing you with energy efficiency advice, taking the form of a personalised report and follow up consultations where appropriate, that will help you reduce your energy use. The Trust will retain your data for the purposes of carrying out research and statistical analysis into the energy efficiency of UK housing stock. Your local Energy Conservation Authority will also receive your data for the purposes of energy efficiency monitoring, targeting and reporting.
In future, the Trust may wish to send you further information including details of grants, special promotions and free offers which will help you save money on your energy bills. If you are happy to receive this please cross here

Thank you for completing this questionnaire. Please make sure that your computer is connected to the internet (on line) and then click the 'Send survey' button.

If you you close this window without sending the survey none of the information you have entered will be saved.

We hope to be able to send you your energy efficiency advice through the normal letter post within a few days - so please make sure that you have included your full name and address!