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ENVIRONMENTAL AND USE QUESTIONNAIRE

Questionnaire n° ____________________ (this field is filled in by Isopan only)

DETAILS OF THE ISOPAN CLIENT*

COMPANY NAME

PROFESSIONAL ACTIVITY

ADDRESS

POSTAL CODE TOWN

PROVINCE STATE

PHONE FAX

E-MAIL
* intended as legal entities or individuals who have purchased the products directly from ISOPAN.

DETAILS OF END USER**

COMPANY NAME

PROFESSIONAL ACTIVITY

ADDRESS

POSTAL CODE TOWN

PROVINCE STATE

PHONE FAX

E-MAIL
** intended as the legal entities or individuals who own the products, who use them and have not purchased them in order
to sell them to Third Parties or for commercial purposes.
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TYPE OF PRODUCT BEING PURCHASED

PRODUCT Specify whether installation will be on wall or roof:

INSULATION Specify whether polyurethane or mineral wool:

SURFACES (m2)

SLOPE (if installed on roof)

PANEL simple-skin / double-skin simple-skin double-skin

TYPE OF JOB (choose from options available)

New building

Restructuring

INTENDED USE
Residential

Offices

Warehouses

Industrial buildings, workshops, shelter for work vehicles, etc.

Cold rooms, processing rooms, etc.

Buildings for livestock use, pack barn, farm vehicle shelter, etc.

Other (specify)

ACTIVITIES IN THE BUILDING (choose from options available)

Presence and/or use and/or storage of chemical products

Presence and/or use and/or storage of fermenting products

Presence of animals in the building

Types of animals present
________________________________ Density of animals (animals / m2) _______________

Emission of gas, vapours and fumes

Devices used to discharge vapours and fumes (extractor, chimney, natural ventilation, forced ventilation, other)

Other (specify)
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GEOGRAPHICAL POSITION OF BUILDING /SITE

ADDRESS

POSTAL CODE TOWN

PROVINCE STATE

ENVIRONMENT THE BUILDING IS LOCATED IN

THE BUILDING IS LOCATED Choose from options available

In a rural area

Near one or more buildings housing animals (specify distance from building: ………… m )

Near one or more buildings used to store fermenting products (specify distance from building: …….. m)

Near fuel oil heating fume generators (specify distance from building: …………. m )
Near built-up urban areas and/or an industrial area including one or more factories producing gas and/or fumes
and/or vapours (specify distance from building and type of gas, fumes or vapours: ……… m )
Near built-up areas and/or an industrial area including, in particular, refineries, incinerators, distilleries, cement
factories, paper mills, laboratories (specify distance from building: …… m )
Near the seafront: outside a building situated less than 1 km from the coast with no possibility for seawater to touch it
directly and seawater vapour to affect the building directly
Near the seafront: outside a building situated less than 1 km from the coast with partial or temporary possibility for the
seawater and/or seawater spray to touch it directly.
In a coastal area: outside a building situated at between 1 and 3 km from the coast, with no possibility for seawater to
touch it directly and the seawater vapour to affect the building directly
In a coastal area: outside a building situated at between 1 and 3 km from the coast, with partial or temporary
possibility for the seawater and/or seawater spray to touch it directly In a marine environment (outside a building
situated between 3 and 20 km from the coast)
In a mixed environment (concurrence of a coastal environment and a normal urban and industrial environment or with
intense conditions)
In a special, specific environment (concurrence of the above exposures and certain additional effects such as abrasion,
high temperatures, high hygrometer measurements, consistent dust deposits, etc.)

Over 900m a.s.l.

ALTITUDE
Below 900m a.s.l.

Strong
SOLAR
RADIATION Medium

Low
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Strong
FREQUENCY OF
RAIN Medium

Low

Strong
FREQUENCY OF
SNOWFALLS Medium

Low

INFORMATION /ADDITIONAL COMMENTS

Date
dd/mm/yyyy

__________________________________________

Signature of Client - Reseller

__________________________________________

Signature of Client - End User

__________________________________________