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 Gloucestershire 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
cavity wall
 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.
solid 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
room thermostat
Timer/Programmer Yes
Timer programmer
TRVs (Thermostatic radiator valve) Yes
Thermostatic radiator valve
Storage heater dials Yes
storage heater dials

 

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
Programmer / timer Yes
Timer programmer
Hot water tank thermostat Yes
tank thermostat

 

 

 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:
This electronic survey is targeted at householders to help you keep your energy costs down. The information will be kept by the Energy Saving Trust for the purpose of carrying out research into energy efficiency. The Energy Saving Trust may in future wish to send you further relevant information on energy efficiency or other products and services. The Energy Saving Trust may also disclose your details, if relevant to other organisations who may wish to provide you with relevant information on improving energy efficiency or related products. If you do not wish to receive information from the Energy Saving Trust or to have your details disclosed to these organisations please tick 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!