Ceiling Track Pre-Survey Questionnaire
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Contact Name
*
First Name
Last Name
Company Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
First line of address
Street Address Line 2
City
State / Province
Postal Code
What type of building needs the ceiling track solution?
*
Detached house
Semi Detached house
Bungalow
Flat
Other
Which room(s) need track installing?
*
Bedroom
Toilet
Bathroom
Lounge
Play Area
Pool
Jacuzzi
Other
What floor is the hoist for?
*
Ground
First Floor
Other
Is there easy access to the loft or ceiling?
*
Yes
No
Don't know
Is there a room above?
*
Yes
No
Unknown
What type of track is needed?
*
Single Track
H system or XY Track
Multiple
Unsure?
What type of transfers do you need the hoist for?
e.g. Bed to wheelchair, wheelchair to bed.
Are there any technical drawings?
*
Yes
No
Please upload any supporting documents
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Choose a file
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Do you know of any structural issues with installing a hoist?
*
Yes
No
Don't Know
If Yes, please explain
Is there easy parking near the building for the surveyor?
*
Yes
No
Is there a complete by date?
-
Day
-
Month
Year
Is there a deadline?
How will the project be funded?
*
Private
Charity
Government Grant
Please verify that you are human
*
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