Magnatech Site Survey Form

Please complete all fields as accurately as possible.

* fields are mandatory.

Client Name

Installation Quotation Authorised by

Address for Installation

Contact Email Address

example@example.com

Contact Phone No. Office

Contact Phone No. Mobile

Boiler/Furnace/Dryer/Water Heater (please circle)

If it’s a Boiler - What is the Purpose of it? Space Heating/Hot Water/Steam Production etc
*

Other. Please Specify:

Thermostat on System (Y/N)*

Separate Meter for System (Y/N)*

Boiler Brand and Model Number

Annual Gas/Oil/LPG Usage

Max Output in kWh or BTU*

Annual Consumption Data Available? (Y/N)

Do You Receive Gas Emissions Analysis in Your Energy Bill? (Y/N)

Fuel Intake Pipe Diameter in mm:

Closest to Burner

Second Section

Fuel Intake Pipe Clear Length in mm:

Second Section

Third Section

Burner Maintenance Agreement in Place? (Y / N)

PLEASE ALSO PROVIDE PHOTOS OF THE INLET GAS/OIL/LPG PIPES

Please submit the completed form by clicking the link below or email to: info@magnatechsystems.com