Please complete all of the
form and click on the Submit button when finished. You will be provided with a
free evaluation of the energy efficiency of your home and guidance on what other
energy efficiency measures you could take.
If you would like a
paper copy of this form for someone else who, for example, may not have
access to the internet, please use the Contact page to
request one making sure you include the address to which you would like it sent.
Your
home
1. What is your property type?
2. What type of home do you live in?
3. In what year was your home built?
4. Do you own or rent your property?
5. Does your home have a heated conservatory,
and if so are its windows double-glazed?
6.
How many rooms (bed, living and dining) do you have? (include hall stairs
and landing as one room)
(enter number)
7. How many storeys does your property have?
(for flats and maisonettes only include your home not the whole block)
8. Does your home have a garage built into the
house?
If you live in a flat please answer
questions 9 to 11. If not go to question 12.
9. Is your flat?
10. Where is your flat positioned in the building?
11. How many walls of your flat are fully exposed to the
outside?
For all types of property
12. What is your main wall type?
13. How much loft insulation do
you have?
14. How much of the property is double-glazed?
15. If you have any single glazed windows are they draught proofed?
16.
How many open fire places with chimneys do you have?
(enter number)
17. How many of your lights have low energy light bulbs
fitted?
18. Are you thinking of buying a new electrical appliance
for your home in the future?
19. What is the main fuel used to heat your
property?
20. What is your main heating
system?
If the main heating system is
a boiler
21a. When was you boiler
installed?
21b. What type of boiler does
your property have?
Or, if the main
heating system is storage heaters
22. What type of storage heaters
are there?
Or, if the main
heating system is room heaters
23. What type of room heaters are
there?
For all types of
heating system
24. What heating controls does your system have? (check all that apply)
Room
thermostat (temperature control)
Programmer (time clock)
Thermostatic
radiator valves (TRVs)
25. What is your secondary heating fuel?
26. What type of secondary room
heaters are there?
27. How is your hot water
usually heated?
28. What is the size of your hot water
cylinder?
29. What type of hot water cylinder insulation
do you have?
30. Is there a thermostat on the
water cylinder?
31. Is solar water heating
present?
The following questions will
help us to tell if you may be eligible for a grant:
32. Is a member of your household
over 60?
Yes
No
33. Is a member of your household
in receipt of benefits?
Yes
No
Data
Protection Statement
The Energy Saving Trust
(EST), 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. EST will retain your data for the purpose 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, EST may wish to send you further information including
details of grants, special promotions and free offers which can save you
money on your energy bills.
If you are happy to receive this help, please select here:
Recent Changes (In this
section, please select 'No' if you do not know.)
34. Have you installed any of the following in
the last 12 months?
a) Cavity wall insulation
No
Yes
b) Loft insulation
c) Draughtproofing
No
Yes
d) Double glazing
No
Yes
e) New boilers
No
Yes
f) Hot water tank jacket
No
Yes
35. Did you change your heating
system in the last 12 months, and if the answer is Yes what was it
previously?
36. Did you change your heating
fuel in the last 12 months, and if the answer is Yes what was it
previously?
Data Protection Statement
The EEAC/SEC, as the data controller, is collecting this 'recent changes'
information for the purposes of carrying out research and statistical
analysis. Your local Energy Conservation authority will also receive your
data for the purposes of energy efficiency monitoring, targeting and
reporting. We may also use this information to send you updated energy
efficiency advice. We may also disclose your details to further
appropriate organisations who may wish to send you similar information.
If you are happy to receive
this help, please select here:
Once you have completed all the questions
please use the Submit button. If all necessary questions have not been
answered you will be prompted which questions still need to be completed. Use the
Reset button to clear the form.
