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
