Tenant:	Job Number:
Address:	Surveyor:
Date of Survey:
Time:
External Temperature:
Tel:	Weather Conditions:
Thermostat Temperature:
Email:	Thermostat Setting / Heating Frequency:
Number of occupants (inc. pets) at time of visit:	( )

Room	Relative Humidity	Air Temp.	Dew Point	Wall Temp.	Floor Covering (Yes / No + type)	Window Covering (Yes / No + type)	Extraction / Ventilation (Yes / No + Pass / Fail)
Hallway
Kitchen
Dining Room
Living Room
Bathroom
Bedroom 1
Bedroom 2
Bedroom 3
Bedroom 4

Tenants’ description of the issues and expected resolution (include date and signature):

Signature:	Date:

Surveyors’ observations:

Root Cause Identified:

Root Cause Definition	/
Condensation:
Penetrating Damp:
Rising Damp:
Leaks:
Insulation (insufficient or missing):

Advice given to tenant:

Referrals Required:

/	Reason
Energy Advice:
Money Advice:
Digital Inclusion:

Repairs required:

Trade	Band	Description	Asbestos?

Mould Treatment:

2 Stage Ceiling	2 Stage Walls	Reseal	Stripping	Stripping Woodchip	4 Stage Ceiling	4 Stage Walls	Sempatap
Lounge
Kitchen
Dining Room
WC
Bathroom
Bedroom 1
Bedroom 2
Bedroom 3
Hallway