SAMPLE ENERGY AUDIT QUESTIONNAIRES

General

Contact name:

Address:

Phone:

 Email:

Square footage of home:

Do you own your home: No \Yes

Is your home more than five years old? No \Yes

How many years since your last remodel?

Step 1: Lighting

1. Number of incandescent lights:

2. Number of fluorescent lights:

3. N.B. Standard T12 lighting has two pins on the end and the light itself is 1 ½ inch Diameter.

If you are unable to remove a light to check, look to see if the home owner has extras in storage and check those.

4. Do you have occupancy sensors or lighting controls on the interior? No Yes

5. Are they LED or incandescent? Incandescent LED

6. How many exits (doors/ windows) are there?

Lighting Tips

• Retrofit T12 lights to T8 lights with electronic ballasts• Turn off some of your lights if you can

• Remove lamps - consider disconnecting power to unused ballasts

• Replace incandescent light lamps with compact fluorescent lamps

• Install dimmer switches, where applicable

• Control exterior lighting with a photocell/time clock

• Reduce ambient light and increase task lighting

Step 2: Insulation

Do you have insulation in your wall? No Yes

What is the R-Value? What is the thickness?

Do you have insulation in your ceiling? No Yes

What is the R-Value? What is the thickness?

Step 3: Air Conditioning

Do you have Air Conditioning? No Yes

Do you have a regular maintenance schedule for heating/cooling equipment? No Yes

Who is your HVAC service contractor? When was the last date of service?

Air Conditioning Tips

• Replace older systems with energy-efficient systems

• Install ceiling and wall insulation

• Service your equipment on the schedule your HVAC service contractor recommends

Step 4: Water Heating

How do you heat your water for your home?

None Gas Water Heater Electric Water Heater Solar Water Heater

Step 5: Foodservice equipment

Refrigeration:

Do your refrigerator doors seal correctly? No Yes

Do you maintain the proper temperatures? No Yes No

Who is your refrigeration service contractor? When was the last date of service?

Cooking:

Do you turn equipment off when not in use? No Yes

Do you have a maintenance program for cooking equipment? No Yes

Is your equipment rated for energy efficiency, such as ENERGY STAR? No Yes

Step 5: Foodservice Equipment Tips.

• Keep equipment clean–carbon and grease build-up make your cooking equipment work

harder and use more energy

• Run full loads when you use your dishwasher

• Turn off tank heaters and hot water recirculation pumps when the facility is closed

• Look for ways to reduce hot water use in the kitchen

• Fix water leaks – one leaky faucet can waste up to 2,000 gallons of water per year

• Use a lid on stockpots to hold in heat, boost efficiency and shorten cook times

• Replace older equipment with ENERGY STAR rated equipment

Step 6: Equipment

Do you have ENERGY STAR rated equipment? No Yes

Are your computers, monitors and other equipment plugged into a power supply strip that

can be switched off during non-use hours? No Yes

Equipment Tips

• Turn off all equipment and lights every night – if you can’t turn off the computer, turn off the Monitor and the printer

• Purchase ENERGY STAR computers, monitors, printers— these models "power down" after a User    pacified period of inactivity

• Use laptop computers and inkjet printers — they consume 90 percent less energy than Standard desktop computers

• Use e-mail instead of printed documents

Step 7: Make Improvements

After reviewing this form what energy saving projects are you looking to implement today?

Food service

Water Heating

Air Conditioning

Insulation

Lighting

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