Request An Energy Survey
Use this form to request an energy survey as part of the Local Energy Advice Demonstrator project. (LEAD). The project is a result of a successful funding bid by Surrey County Council and Zero Carbon Guildford (ZCG), with funding provided by the Department for Energy Security and Net Zero (DESNZ). ZCG is working with a number of community partners across Surrey (logos above) to deliver the in-person advice, so the Energy Champion who visits you will be from your local associated group. You are not compelled to answer questions without a *, and these answers are provided with your explicit consent when you complete the answer. We need to ask these questions because there are eligibility criteria attached to the funding that makes the free surveys possible, and completing this form does not guarantee that you will receive a survey. Your data will be handled in accordance with UK GPDR law. Please note that our Energy Champions are trained community volunteers, they are not Retrofit Assessors. Any requests or calculations beyond the scope of their training will need to be referred to a Retrofit Assessor.
Eligible?
Survey Group
Report Sent
About You
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Postcode
*
Phone number
*
Any information on how to find your property (bearing in mind it will often be dark when we arrive) and where best to park?
Preferred days / evenings for survey visit
*
My housing status in regards to the above property is:
*
Owner occupier
Private tenant
Social tenant
Landlord
Shared ownership
Other
Council tax band: (this will help us determine if you're eligible for some funding streams)
A-D
E-G
Don't know
Eligibility
The LEAD funding criteria prioritises target audiences that will benefit most from in-person energy advice. Your information is stored securely in line with special category data rules, and we will not use it to contact you for anything other than activities related to this energy project. View Zero Carbon Guildford's Privacy Policy for more details. Data is deleted after 12 months.
House type
*
flat
terraced
semi detached
detached
park home / house boat
Other
Number of bedrooms
*
Does your home have gas central heating?
*
Yes
No
Don't know
Is English the 1st language in your home?
Yes
No
What is your ethnicity? (options based on high-level UK Census questions and are a required part of the eligibility check to ensure target audiences are reached)
Asian, Asian British, Asian Welsh
Black, Black British, Black Welsh, African, Carribean
White
Prefer not to say
Multiple / mixed
Other
Does anyone in your home receive disability benefits?
Yes
No
Don't know
Would you say you are:
Struggling to pay your energy bills
Just about managing
Looking for long term cost savings
None of the above
My Energy Performance Certificate rating is: (find out at www.gov.uk/find-energy-certificate)
*
A-C
D-G
Don't know
Is the home in a conservation zone (check on your district or borough's website)
*
Yes
No
Don't know
Please rank the following factors in terms of why you would like the survey (1 most important, 5 least important)
*
1
2
3
4
5
Lowering Bills
Keeping my home cosy
Cutting carbon emissions
Increasing my home's value
Improving my family's health
Any Particular Concerns
If there are any particular problem areas you want our surveyors to investigate please let us know in the box below. Eg rooms that don't heat properly, draughty spots etc
Type here any particular concerns
Your Energy Use
Knowing how much energy you use will be helpful for us to assess whether you have high usage, spot any reasons your bills might be high, and give advice on how to lower them. If possible, please input your annual electricity / gas / oil use. You will find this information on your bill. The 'estimated annual use' is fine. If you don't have this now, please ensure you have it to hand when the surveyor comes to your house, as this will be critical in understanding any unusual billing patterns and advising on cutting costs.
Annual electricity use (in kWh - this will be on your bill)
Annual gas use, if applicable (in kWh)
Annual oil use, if applicable (in litres)
Please tell us where you heard about this service.
Social media
Word of mouth
BBC
Surrey Live / Advertiser
Local chat group / Whatsapp / Next Door
Zero Carbon Guildford Newsletter
Action Surrey
Energy Matters
My local council / coumcillor
Other
The Local Energy Advice Demonstrator project involves delivery partners Surrey County Council, as well as the local community group delivering the surveys in your area. We can also refer you for up to 5 hrs of in-depth support with grant applications to partners Surrey Climate Commission and Action Surrey. To ensure we can survey your property and provide all available information on grants and offers, please confirm you are happy for your information to be shared between delivery partners. All Energy Champions have signed a Privacy Agreement to protect your information. You will not be contacted for anything outside the scope of this project.
*
Yes
No
Submit
Should be Empty: