Aform

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Email

• Phone Number

• Outside Temperature

• Gas Utility Name

  Consumers

  Michcon

  Semco

• Consumers or Michcon Number

• Electric Utility Name

  DTE

  Consumers

• Electric Utility Number

• House Type

  Select Single-Family Detached Duplex/Townhouse End Unit Townhouse Interior Unit Apartment w 2-4 Units Apartment w 5+ Units Mobile Home

  • Single-Family Detached
  • Duplex/Townhouse End Unit
  • Townhouse Interior Unit
  • Apartment w 2-4 Units
  • Apartment w 5+ Units
  • Mobile Home

• Number of Bedrooms

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• Year Built

  Select pre 1050 1951-1960 1961-1970 1971-1980 1981-1990 1991-1995 1996-2000 2001-2005 post 2005

  • pre 1050
  • 1951-1960
  • 1961-1970
  • 1971-1980
  • 1981-1990
  • 1991-1995
  • 1996-2000
  • 2001-2005
  • post 2005

• Number of Occupants

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• Number of Stories Above Grade

  1

  1.5

  2

  2.5

  3

• House Faces

  Select North NE East SE South SW West NW

  • North
  • NE
  • East
  • SE
  • South
  • SW
  • West
  • NW

• Shielding on Home

  Exposed

  Normal

  Well-Shielded

• Moisture In Attic?

  Yes

  No

  N/A

• Utility Bills

  Actual Utility Bill

  RECS

• Picture of Gas Bill

  Media

• Picture of Electric Bill

  Media

• Primary Cooking Fuel

  Natural Gas

  Electricity

  Propane

• How often is oven/range used to cook? (For propane and gas only)

  Very Frequently: 75+% of meals

  Frequently: 50%-75% of meals

  Moderately: 33%-50% of meals

  Infrequently: 25%-33% of meals

  Very Infrequently: <25% of meals

• Dryer Fuel

  Natural Gas

  Electricity

  Propane

• How many dryer loads per week on average?

Pool - Outdoor pools used in summer

• Is a pool present at the home?

  Yes

  No

  N/A

• When does it open?

• When does it close?

• How many hrs/day does the pump run?

• What is the (HP) of the pool pump?

• Is the pool heated?

  Yes

  No

  N/A

• If the pool is heated, enter fuel type

  Oil

  Propane

  Natural Gas

  Electricity

• Percent of hours that the pool is heated

• Avg Pool Temp

• Approx pool sq ft.

• Percent of pool shaded

• Pool Efficiency

Floor Dimensions

• Home Sq Ft.

• First Floor: Front of House Length (feet)

• First Floor: Side of House Width (feet)

• First Floor Ceiling Height

• Second Floor: Front of House Length (feet)

• Second Floor: Side of House Width (feet)

• Second Floor Ceiling Height

• Third Floor: Front of House Length (feet)

• Third Floor: Front of House Length (feet)

• Third Floor Ceiling Height

• Address Drainage Concerns?

  Yes

  No

  N/A

• Extend Downspouts?

  Yes

  No

  N/A

• Repair/ repalce roof?

  Yes

  No

  N/A

• Repair Exterior Siding?

  Yes

  No

  N/A

• Add attic ventilation from outside?

  Yes

  No

  N/A

Windows and Glass Doors

• Alternative Entry for Group- Total Area (ft2)

• Existing Window Description

  Select Single-pane clear Single-pane tinted Double-pane clear Double-pane tinted Double-pane reflective Double-pane clear low-e Double-pane tinted low-e Triple-pane clear low-e Quadruple-pane clear low-e

  • Single-pane clear
  • Single-pane tinted
  • Double-pane clear
  • Double-pane tinted
  • Double-pane reflective
  • Double-pane clear low-e
  • Double-pane tinted low-e
  • Triple-pane clear low-e
  • Quadruple-pane clear low-e

• Percent facing the sun

• Add window films?

  Yes

  No

  N/A

• Window sq ft needing films

Doors

• Number of Exteior Door Type 1

• Exterior Door 1 Characteristics

  Select Insulated (no Storm) Insulated (with Storm) Solid Core Wood (no Storm) Solid Core Wood (with Storm) Wood Panel (no Storm) Wood Panel (with Storm)

  • Insulated (no Storm)
  • Insulated (with Storm)
  • Solid Core Wood (no Storm)
  • Solid Core Wood (with Storm)
  • Wood Panel (no Storm)
  • Wood Panel (with Storm)

• Proposed Door 1 Action

  No Action Proposed

  Insulated Replacement Door (no Storm)

  Insulated Replacement (with Storm)

  Add Storm

• Number of Exteior Door Type 2

• Exterior Door 2 Characteristics

  Select Insulated (no Storm) Insulated (with Storm) Solid Core Wood (no Storm) Solid Core Wood (with Storm) Wood Panel (no Storm) Wood Panel (with Storm)

  • Insulated (no Storm)
  • Insulated (with Storm)
  • Solid Core Wood (no Storm)
  • Solid Core Wood (with Storm)
  • Wood Panel (no Storm)
  • Wood Panel (with Storm)

• Proposed Door 2 Action

  No Action Proposed

  Insulated Replacement Door (no Storm)

  Insulated Replacement (with Storm)

  Add Storm

Exterior Walls

• Outer Wall Type

  Select Siding Brick Concrete Log SIP ICT

  • Siding
  • Brick
  • Concrete
  • Log
  • SIP
  • ICT

• Wall Stud Width or Wall Depth (Inches)

  Select 4 6 8 2x4 16" OC 2x6 16" OC 2x6 24" OC

  • 4
  • 6
  • 8
  • 2x4 16" OC
  • 2x6 16" OC
  • 2x6 24" OC

• Existing Wall Insulation Condition

  No Insulation

  Poorly Insulated

  Moderately Insulated

  Well-Insulated

• Proposed Wall Insulation

  Select No Action Proposed Fiberglass Batt Fiberglass Batt (high-density) Fiberglass (dense pack) Cellulose (dense pack) Fiberglass (wet spray) Cellulose (wet spray) Foam (low density) Foam (high density)

  • No Action Proposed
  • Fiberglass Batt
  • Fiberglass Batt (high-density)
  • Fiberglass (dense pack)
  • Cellulose (dense pack)
  • Fiberglass (wet spray)
  • Cellulose (wet spray)
  • Foam (low density)
  • Foam (high density)

Cantilevers and Ceilings Over Garages

• Cantilever Area Type1

  Cantilever

  Ceiling Over Basement Garage

  Ceiling Over 1st Floor Garage

• Cantilever Length

• Cantilever Width

• Cantilever Existing Insulation Depth

• Catilever Insulation Condition

  No Insulation

  Poorly Insulated

  Moderately Insulated

  Well-Insulated

• Cantilever Proposed Action

  No Action Proposed

  Install Insulation

• Cantilever Proposed Insulation Upgrade

  Select No Action Proposed Fiberglass Batt Fiberglass Batt (high-density) Fiberglass (dense pack) Cellulose (dense pack) Fiberglass (wet spray) Cellulose (wet spray) Foam (low density) Foam (high density)

  • No Action Proposed
  • Fiberglass Batt
  • Fiberglass Batt (high-density)
  • Fiberglass (dense pack)
  • Cellulose (dense pack)
  • Fiberglass (wet spray)
  • Cellulose (wet spray)
  • Foam (low density)
  • Foam (high density)

• Cantilever Proposed Insulation (inches to be installed)

  4

  6

  8

  10

  12

Attic(s)

• Attic1 Area Length (ft)

• Attic1 Area Width (ft)

• Attic1 Existing Insulation Type

  Select None Cellulose Dense Pack Cellulose Loose Fill Fiberglass Batts Fiberglass Loose Fill High-Density Foam Low-Density Foam Mineral Wool Vermiculite

  • None
  • Cellulose Dense Pack
  • Cellulose Loose Fill
  • Fiberglass Batts
  • Fiberglass Loose Fill
  • High-Density Foam
  • Low-Density Foam
  • Mineral Wool
  • Vermiculite

• Attic1 Existing Insulation Level, (Inches - Round up for Batts)

  Select 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Attic1 Existing Insulation Condition

  No Insulation

  Poorly Insulated

  Moderately Insulated

  Well-Insulated

• Attic1 Proposed Action

  No Action Proposed

  Encapsulate Attic

  Install Insulation

• Attic1 Baffles Needed?

  Yes

  No

  N/A

• Attic2 Area Length (ft)

• Attic2 Area Width (ft)

• Attic2 Existing Insulation Type

  Select None Cellulose Dense Pack Cellulose Loose Fill Fiberglass Batts Fiberglass Loose Fill High-Density Foam Low-Density Foam Mineral Wool Vermiculite

  • None
  • Cellulose Dense Pack
  • Cellulose Loose Fill
  • Fiberglass Batts
  • Fiberglass Loose Fill
  • High-Density Foam
  • Low-Density Foam
  • Mineral Wool
  • Vermiculite

• Attic2 Existing Insulation Level, (Inches - Round up for Batts)

  Select 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Attic2 Existing Insulation Condition

  No Insulation

  Poorly Insulated

  Moderately Insulated

  Well-Insulated

• Attic2 Proposed Action

  No Action Proposed

  Encapsulate Attic

  Install Insulation

• Attic2 Baffles Needed?

  Yes

  No

  N/A

• Attic3 Area Length (ft)

• Attic3 Area Width (ft)

• Attic3 Existing Insulation Type

  Select None Cellulose Dense Pack Cellulose Loose Fill Fiberglass Batts Fiberglass Loose Fill High-Density Foam Low-Density Foam Mineral Wool Vermiculite

  • None
  • Cellulose Dense Pack
  • Cellulose Loose Fill
  • Fiberglass Batts
  • Fiberglass Loose Fill
  • High-Density Foam
  • Low-Density Foam
  • Mineral Wool
  • Vermiculite

• Attic3 Existing Insulation Level, (Inches - Round up for Batts)

  Select 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Attic3 Existing Insulation Condition

  No Insulation

  Poorly Insulated

  Moderately Insulated

  Well-Insulated

• Attic3 Proposed Action

  No Action Proposed

  Encapsulate Attic

  Install Insulation

• Attic3 Baffles Needed?

  Yes

  No

  N/A

Kneewalls and Vertical Attic Walls

• Kneewalll 1 Width (ft)

• Kneewall 1 Height (ft)

• Kneewall Existing Insulation Depth

  Select 1 2 3 4 5 6 7 8 9 10 11 12

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12

• Kneewall Existing Insulation Condition

  No Insulation

  Poorly Insulated

  Moderately Insulated

  Well-Insulated

• Proposed Kneewall 1 Insulation

  Select No Action Proposed Fiberglass Batt Fiberglass Batt (high-density) Fiberglass (dense pack) Cellulose (dense pack) Fiberglass (wet spray) Cellulose (wet spray) Foam (low density) Foam (high density)

  • No Action Proposed
  • Fiberglass Batt
  • Fiberglass Batt (high-density)
  • Fiberglass (dense pack)
  • Cellulose (dense pack)
  • Fiberglass (wet spray)
  • Cellulose (wet spray)
  • Foam (low density)
  • Foam (high density)

• Proposed Kneewall Insulation (inches to be installed)

  Select 1 2 3 4 5 6 7 8 9 10 11 12

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12

• Kneewalll 2 Width (ft)

• Kneewall 2 Height (ft)

• Kneewall 2 Existing Insulation Depth

  Select 1 2 3 4 5 6 7 8 9 10 11 12

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12

• Kneewall 2 Existing Insulation Condition

  No Insulation

  Poorly Insulated

  Moderately Insulated

  Well-Insulated

• Proposed Kneewall 2 Insulation

  Select No Action Proposed Fiberglass Batt Fiberglass Batt (high-density) Fiberglass (dense pack) Cellulose (dense pack) Fiberglass (wet spray) Cellulose (wet spray) Foam (low density) Foam (high density)

  • No Action Proposed
  • Fiberglass Batt
  • Fiberglass Batt (high-density)
  • Fiberglass (dense pack)
  • Cellulose (dense pack)
  • Fiberglass (wet spray)
  • Cellulose (wet spray)
  • Foam (low density)
  • Foam (high density)

• Proposed Kneewall 2 Insulation (inches to be installed)

  Select 1 2 3 4 5 6 7 8 9 10 11 12

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12

Foundations

• Foundation 1 Type

  Select Conditioned Basement Unconditioned Basement Slab Enclosed Crawlspace Open Crawlspace Raised Pier

  • Conditioned Basement
  • Unconditioned Basement
  • Slab
  • Enclosed Crawlspace
  • Open Crawlspace
  • Raised Pier

• Percentage of Foundation 1 Floor Area by Section

• Foundation1 Ceiling Height (ft)

• Foundation 1 Existing Insulation Depth

  Select 0 0.5 1 1.5 2 2.5 3 4 5 6 7 8 9 10 11 12

  • 0
  • 0.5
  • 1
  • 1.5
  • 2
  • 2.5
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12

• Foundation1 Existing Insulation Condition

  No Insulation

  Poorly Insulated

  Moderately Insulated

  Well-Insulated

• Foundation1 Proposed Action

  No Action Proposed

  Seal & Insulate Crawlspace

  Install Insulation

• Foundation1 Proposed Insulation Upgrade

  Select No Action Proposed Fiberglass Batt Fiberglass Batt (high-density) Fiberglass (dense pack) Cellulose (dense pack) Fiberglass (wet spray) Cellulose (wet spray) Foam (low density) Foam (high density)

  • No Action Proposed
  • Fiberglass Batt
  • Fiberglass Batt (high-density)
  • Fiberglass (dense pack)
  • Cellulose (dense pack)
  • Fiberglass (wet spray)
  • Cellulose (wet spray)
  • Foam (low density)
  • Foam (high density)

• Foundation1 Proposed Insulation (inches to be installed)

  Select 1 2 3 4 5 6 7 8 9 10 11 12

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12

• Foundation 1Waterproof/Vapor Barrier Basement or Crawlspace Walls/Floor

  Yes

  No

  N/A

• Basement 1 ceiling type

  Unfinished

  Partially Finished

  Drop Ceiling

  Finished

• Foundation 2 Type

  Select Conditioned Basement Unconditioned Basement Slab Enclosed Crawlspace Open Crawlspace Raised Pier

  • Conditioned Basement
  • Unconditioned Basement
  • Slab
  • Enclosed Crawlspace
  • Open Crawlspace
  • Raised Pier

• Percentage of Foundation 2 Floor Area by Section

• Foundation2 Ceiling Height (ft)

• Foundation 2 Existing Insulation Depth

  Select 0 0.5 1 1.5 2 2.5 3 4 5 6 7 8 9 10 11 12

  • 0
  • 0.5
  • 1
  • 1.5
  • 2
  • 2.5
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12

• Foundation2 Existing Insulation Condition

  No Insulation

  Poorly Insulated

  Moderately Insulated

  Well-Insulated

• Foundation2 Proposed Action

  No Action Proposed

  Seal & Insulate Crawlspace

  Install Insulation

• Foundation2 Proposed Insulation Upgrade

  Select No Action Proposed Fiberglass Batt Fiberglass Batt (high-density) Fiberglass (dense pack) Cellulose (dense pack) Fiberglass (wet spray) Cellulose (wet spray) Foam (low density) Foam (high density)

  • No Action Proposed
  • Fiberglass Batt
  • Fiberglass Batt (high-density)
  • Fiberglass (dense pack)
  • Cellulose (dense pack)
  • Fiberglass (wet spray)
  • Cellulose (wet spray)
  • Foam (low density)
  • Foam (high density)

• Foundation2 Proposed Insulation (inches to be installed)

  Select 1 2 3 4 5 6 7 8 9 10 11 12

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12

• Foundation 2 Waterproof/Vapor Barrier Basement or Crawlspace Walls/Floor

  Yes

  No

  N/A

• Basement 2 ceiling type

  Unfinished

  Partially Finished

  Drop Ceiling

  Finished

Rim and Band Joist

• Ln Ft of Rim/ Band Joist

• Rim and Band Insulation Depth

• Rim and Band Insulation Type

  Select No Action Proposed Fiberglass Batt Fiberglass Batt (high-density) Fiberglass (dense pack) Cellulose (dense pack) Fiberglass (wet spray) Cellulose (wet spray) Foam (low density) Foam (high density)

  • No Action Proposed
  • Fiberglass Batt
  • Fiberglass Batt (high-density)
  • Fiberglass (dense pack)
  • Cellulose (dense pack)
  • Fiberglass (wet spray)
  • Cellulose (wet spray)
  • Foam (low density)
  • Foam (high density)

• Rim and Band Existing Insulation Condtion

  No Insulation

  Poorly Insulated

  Moderately Insulated

  Well-Insulated

• Spray Foam Needed?

  Yes

  No

  N/A

Lighting, Appliances & Smart Strips

• CFL Count

• Replace Clothes Washer

  Yes

  No

  N/A

• Replace Dehumidfier

  Yes

  No

  N/A

• Replace Refrigerator

  Yes

  No

  N/A

• Replace Dishwasher

  Yes

  No

  N/A

• Replace Freezer

  Yes

  No

  N/A

Oven Carbon Monoxide Testing

• Oven Fuel Type

  Oil

  Propane

  Natural Gas

  Electricity

• CO Level from Oven (ppm)

• Oven Proposed Action

  No Action Proposed

  Clean & Tune Oven

  Install Co Detector

  Clean & Tune Oven, Install CO Detector

Ambient CO Testing

• Ambient CO in Living Space (ppm)

• Ambient CO Proposed Action

  No Action Proposed

  Install CO and/or Smoke Detector(s)

  Mitigate CO in Area

  Mitigate CO & Install Detector(s)

Combustion Appliance Zone (CAZ) Testing

• CAZ1 Venting Configuration

  Select Isolated CAZ Orphan natural draft DHW Natural draft boiler/furnace w DHW Nat draft boiler/furnace w DHW & Damper Individual nat draft boiler/furnace Mech assisted boiler/furnace w DHW Mech assist boiler/furnace/DHW alone Exhaust chimney-top draft inducer fan Hi static press flame retention-head oil Sealed combustion

  • Isolated CAZ
  • Orphan natural draft DHW
  • Natural draft boiler/furnace w DHW
  • Nat draft boiler/furnace w DHW & Damper
  • Individual nat draft boiler/furnace
  • Mech assisted boiler/furnace w DHW
  • Mech assist boiler/furnace/DHW alone
  • Exhaust chimney-top draft inducer fan
  • Hi static press flame retention-head oil
  • Sealed combustion

• CAZ1 Baseline

• CAZ1 2nd Reading

• CAZ1 Worst Case

• CAZ1 ambient CO ppm

• CAZ1 Pass?

  Yes

  No

  N/A

• CAZ Gas leaks?

  Yes

  No

  N/A

• CAZ1 Notes

• CAZ2 Venting Configuration

  Select Isolated CAZ Orphan natural draft DHW Natural draft boiler/furnace w DHW Nat draft boiler/furnace w DHW & Damper Individual nat draft boiler/furnace Mech assisted boiler/furnace w DHW Mech assist boiler/furnace/DHW alone Exhaust chimney-top draft inducer fan Hi static press flame retention-head oil Sealed combustion

  • Isolated CAZ
  • Orphan natural draft DHW
  • Natural draft boiler/furnace w DHW
  • Nat draft boiler/furnace w DHW & Damper
  • Individual nat draft boiler/furnace
  • Mech assisted boiler/furnace w DHW
  • Mech assist boiler/furnace/DHW alone
  • Exhaust chimney-top draft inducer fan
  • Hi static press flame retention-head oil
  • Sealed combustion

• CAZ2 Baseline

• CAZ2 2nd Reading

• CAZ2 Worst Case

• CAZ2 ambient CO ppm

• CAZ2 Pass?

  Yes

  No

  N/A

• CAZ2 Notes

Domestic Hot Water

• DHW 1 Fuel

  Natural Gas

  Electricity

  Oil

  Propane

• DHW 1 System Type

  Select Storage (Tank) Condensing Storage (Tank) Demand (Tankless) Heat Pump (Tank) High Output Solar (Tank) Solar (Tank) Indirect (with Space Heating Boiler) Integrated (with Supplemental Space Heating)

  • Storage (Tank)
  • Condensing Storage (Tank)
  • Demand (Tankless)
  • Heat Pump (Tank)
  • High Output Solar (Tank)
  • Solar (Tank)
  • Indirect (with Space Heating Boiler)
  • Integrated (with Supplemental Space Heating)

• DHW1 Vintage (Install Date)

  Select 1970-1979 1980-1985 1986-1991 1992-1995 1996-2000 2001-2005 Post-2005

  • 1970-1979
  • 1980-1985
  • 1986-1991
  • 1992-1995
  • 1996-2000
  • 2001-2005
  • Post-2005

• DHW1 System Venting Configuration

  Select Electric, indirect tank or tankless coil Isolated CAZ Atmospheric- Individual Appl Atmospheric- Comm. Vent w Other Appl(s) Fan-Assisted or Induced Draft B-Vent Direct-Vent or Power-Vented

  • Electric, indirect tank or tankless coil
  • Isolated CAZ
  • Atmospheric- Individual Appl
  • Atmospheric- Comm. Vent w Other Appl(s)
  • Fan-Assisted or Induced Draft
  • B-Vent
  • Direct-Vent or Power-Vented

• DHW1 Visible Signs of Corrosion (potential exhaust spillage)?

  Yes

  No

  N/A

• DHW1 Load Served by System (% of overall load)

• DHW1 System Efficiency (High or Regular Efficiency)

  High Efficiency

  Regular Efficiency

• DHW 1 Setpoint

• DHW 1 System Spillage Test

  Yes

  No

  N/A

• DHW1 CO ppm

• DHW1 Notes

• DHW 2 Fuel

  Natural Gas

  Electricity

  Oil

  Propane

• DHW 2 System Type

  Select Storage (Tank) Condensing Storage (Tank) Demand (Tankless) Heat Pump (Tank) High Output Solar (Tank) Solar (Tank) Indirect (with Space Heating Boiler) Integrated (with Supplemental Space Heating)

  • Storage (Tank)
  • Condensing Storage (Tank)
  • Demand (Tankless)
  • Heat Pump (Tank)
  • High Output Solar (Tank)
  • Solar (Tank)
  • Indirect (with Space Heating Boiler)
  • Integrated (with Supplemental Space Heating)

• DHW 2 Vintage (Install Date)

  Select 1970-1979 1980-1985 1986-1991 1992-1995 1996-2000 2001-2005 Post-2005

  • 1970-1979
  • 1980-1985
  • 1986-1991
  • 1992-1995
  • 1996-2000
  • 2001-2005
  • Post-2005

• DHW2 System Venting Configuration

  Select Electric, indirect tank or tankless coil Isolated CAZ Atmospheric- Individual Appl Atmospheric- Comm. Vent w Other Appl(s) Fan-Assisted or Induced Draft B-Vent Direct-Vent or Power-Vented

  • Electric, indirect tank or tankless coil
  • Isolated CAZ
  • Atmospheric- Individual Appl
  • Atmospheric- Comm. Vent w Other Appl(s)
  • Fan-Assisted or Induced Draft
  • B-Vent
  • Direct-Vent or Power-Vented

• DHW2 Visible Signs of Corrosion (potential exhaust spillage)?

  Yes

  No

  N/A

• DHW2 Load Served by System (% of overall load)

• DHW2 System Efficiency (High or Regular Efficiency)

  High Efficiency

  Regular Efficiency

• DHW 2 Setpoint

• DHW 2 System Spillage Test

  Yes

  No

  N/A

• DHW2 CO ppm

• DHW2 Notes

Heating Systems

• Heating System 1 Fuel Type

  Natural Gas

  Electricity

  Oil

  Propane

• Heating System 1 Type

  Select Furnace Heat Pump Geothermal Heat Pump Water-to-Air Heat Pump Mini-split Heat Pump Window or Room Heat Pump Boiler Direct Heater

  • Furnace
  • Heat Pump
  • Geothermal Heat Pump
  • Water-to-Air Heat Pump
  • Mini-split Heat Pump
  • Window or Room Heat Pump
  • Boiler
  • Direct Heater

• Existing Heating System 1 Vintage (Install Date)

  Select 1970-1979 1980-1985 1986-1991 1992-1995 1996-2000 High Efficiency 1996-2000 Std Efficiency 2001-2005 High Efficiency 2001-2005 Std Efficiency Post-2005 High Efficiency Post-2005 Std Efficiency

  • 1970-1979
  • 1980-1985
  • 1986-1991
  • 1992-1995
  • 1996-2000 High Efficiency
  • 1996-2000 Std Efficiency
  • 2001-2005 High Efficiency
  • 2001-2005 Std Efficiency
  • Post-2005 High Efficiency
  • Post-2005 Std Efficiency

• Heating System 1 Venting Configuration

  Select Electric Isolated CAZ Atmospheric- Individual Appl Atmospheric- Comm. Vent w Other Appl(s) Fan-Assisted or Induced Draft B-Vent Direct-Vent or Power-Vented Sealed Combustion Unvented Direct Heater

  • Electric
  • Isolated CAZ
  • Atmospheric- Individual Appl
  • Atmospheric- Comm. Vent w Other Appl(s)
  • Fan-Assisted or Induced Draft
  • B-Vent
  • Direct-Vent or Power-Vented
  • Sealed Combustion
  • Unvented Direct Heater

• Visible Signs of Corrosion Heating 1 (potential exhaust spillage)?

  Yes

  No

  N/A

• Percentage of Heating Load served by system 1

• Distribution System Type 1

  Air Duct System

  Hydronic System

  Electric Resistance Baseboard

• Approx System Capacity System 1 (kBTU/h)

• Heating 1 AFUE Efficiency

• Testo used on Heating 1

  Yes

  No

  N/A

• Heating System1 Pass Spillage?

  Yes

  No

  N/A

• Heating System1 CO

• Heating System 2 Fuel Type

  Natural Gas

  Electricity

  Oil

  Propane

• Heating System 2 Type

  Select Furnace Heat Pump Geothermal Heat Pump Water-to-Air Heat Pump Mini-split Heat Pump Window or Room Heat Pump Boiler Direct Heater

  • Furnace
  • Heat Pump
  • Geothermal Heat Pump
  • Water-to-Air Heat Pump
  • Mini-split Heat Pump
  • Window or Room Heat Pump
  • Boiler
  • Direct Heater

• Existing Heating System 2 Vintage (Install Date)

  Select 1970-1979 1980-1985 1986-1991 1992-1995 1996-2000 High Efficiency 1996-2000 Std Efficiency 2001-2005 High Efficiency 2001-2005 Std Efficiency Post-2005 High Efficiency Post-2005 Std Efficiency

  • 1970-1979
  • 1980-1985
  • 1986-1991
  • 1992-1995
  • 1996-2000 High Efficiency
  • 1996-2000 Std Efficiency
  • 2001-2005 High Efficiency
  • 2001-2005 Std Efficiency
  • Post-2005 High Efficiency
  • Post-2005 Std Efficiency

• Heating System 2 Venting Configuration

  Select Electric Isolated CAZ Atmospheric- Individual Appl Atmospheric- Comm. Vent w Other Appl(s) Fan-Assisted or Induced Draft B-Vent Direct-Vent or Power-Vented Sealed Combustion Unvented Direct Heater

  • Electric
  • Isolated CAZ
  • Atmospheric- Individual Appl
  • Atmospheric- Comm. Vent w Other Appl(s)
  • Fan-Assisted or Induced Draft
  • B-Vent
  • Direct-Vent or Power-Vented
  • Sealed Combustion
  • Unvented Direct Heater

• Visible Signs of Corrosion Heating 2 (potential exhaust spillage)?

  Yes

  No

  N/A

• Percentage of Heating Load served by system 2

• Distribution System Type 2

  Air Duct System

  Hydronic System

  Electric Resistance Baseboard

• Approx System Capacity System 1 (kBTU/h)

• Heating 2 AFUE Efficiency

• Testo used on Heating 2

  Yes

  No

  N/A

• Heating System2 Pass Spillage?

  Yes

  No

  N/A

• Heating System2 CO

Cooling Systems

• Enter Type of Cooling System 1

  Central AC

  Window or Room AC

  Mini-split AC

• Approximate Cooling System1 Capacity (tons)

• Existing Cooling System 1 Vintage (Install Date)

  Select 1970-1979 1980-1985 1986-1991 1992-1995 1996-2000 High Efficiency 1996-2000 Std Efficiency 2001-2005 High Efficiency 2001-2005 Std Efficiency Post-2005 High Efficiency Post-2005 Std Efficiency

  • 1970-1979
  • 1980-1985
  • 1986-1991
  • 1992-1995
  • 1996-2000 High Efficiency
  • 1996-2000 Std Efficiency
  • 2001-2005 High Efficiency
  • 2001-2005 Std Efficiency
  • Post-2005 High Efficiency
  • Post-2005 Std Efficiency

• Existing Cooling System 1 with ECM-type Blower Fan (for Air Duct Systems)?

  Yes

  No

  N/A

• Enter Type of Cooling System 2

  Central AC

  Window or Room AC

  Mini-split AC

• Approximate Cooling System2 Capacity (tons)

• Existing Cooling System 2 Vintage (Install Date)

  Select 1970-1979 1980-1985 1986-1991 1992-1995 1996-2000 High Efficiency 1996-2000 Std Efficiency 2001-2005 High Efficiency 2001-2005 Std Efficiency Post-2005 High Efficiency Post-2005 Std Efficiency

  • 1970-1979
  • 1980-1985
  • 1986-1991
  • 1992-1995
  • 1996-2000 High Efficiency
  • 1996-2000 Std Efficiency
  • 2001-2005 High Efficiency
  • 2001-2005 Std Efficiency
  • Post-2005 High Efficiency
  • Post-2005 Std Efficiency

• Existing Cooling System 2 with ECM-type Blower Fan (for Air Duct Systems)?

  Yes

  No

  N/A

Ducts

• Existing Duct Type 1

  Metal

  Duct Board

  Flexible Duct

• Existing Heating System(s) Served 1

  System 1

  System 2

  System 1 & 2

• Existing Cooling System(s) Served 1

  System 1

  System 2

  System 1 & 2

• Existing Percentage of Ductwork Outside of Conditioned Space 1

  Select 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

  • 0
  • 5
  • 10
  • 15
  • 20
  • 25
  • 30
  • 35
  • 40
  • 45
  • 50
  • 55
  • 60
  • 65
  • 70
  • 75
  • 80
  • 85
  • 90
  • 95
  • 100

• Existing Duct Location Outside of Conditioned Space 1

  Attic

  Garage

  Unconditioned Basement

  Unconditioned Crawlspace

  Conditioned Space

• Existing Duct Insulation R-Value

  Select 0 2 4 6 8 10

  • 0
  • 2
  • 4
  • 6
  • 8
  • 10

• Existing Estimated Duct Leakage

  Tested

  Loose

  Moderate

  Tight

• Existing Duct Type 2

  Metal

  Duct Board

  Flexible Duct

• Existing Heating System(s) Served 2

  System 1

  System 2

  System 1 & 2

• Existing Cooling System(s) Served 2

  System 1

  System 2

  System 1 & 2

• Existing Percentage of Ductwork Outside of Conditioned Space 2

  Select 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

  • 0
  • 5
  • 10
  • 15
  • 20
  • 25
  • 30
  • 35
  • 40
  • 45
  • 50
  • 55
  • 60
  • 65
  • 70
  • 75
  • 80
  • 85
  • 90
  • 95
  • 100

• Existing Duct Location Outside of Conditioned Space 2

  Attic

  Garage

  Unconditioned Basement

  Unconditioned Crawlspace

  Conditioned Space

Air Leakage

• BAS Minimum

• BAS Maximim

• BD test in number

• Air Leakage Locations

  Select Windows Doors Recessed Lights Attic Hitch Supply Registers Return Registers

  • Windows
  • Doors
  • Recessed Lights
  • Attic Hitch
  • Supply Registers
  • Return Registers

• Type of weatherstripping needed

  Select Kerf Rubber Foam Door Threshold Door Sweep Rope Caulk

  • Kerf
  • Rubber
  • Foam
  • Door Threshold
  • Door Sweep
  • Rope Caulk

upgrade info

• Pets Present?

  Select small dog medium dog large dog multiple small dogs multiple medium dogs multiple large dogs cat two cats birds

  • small dog
  • medium dog
  • large dog
  • multiple small dogs
  • multiple medium dogs
  • multiple large dogs
  • cat
  • two cats
  • birds

• Homeowner's Main Concerns

• Referred By:

• Air Seal Sold?

  Yes

  No

  N/A

• What places to air seal

• Air Seal Notes

• Air Sealing Pictures

  Media

• Air Sealing Pictures

  Media

• Air Sealing Pictures

  Media

• Air Sealing Pictures

  Media

• Air Sealing Pictures

  Media

• Air Sealing Pictures

  Media

• Air Sealing Pictures

  Media

• Air Sealing Pictures

  Media

• Air Sealing Pictures

  Media

• Air Sealing Pictures

  Media

• Air Sealing Pictures

  Media

• Air Sealing Pictures

  Media

• Air Sealing Pictures

  Media

• Air Sealing Pictures

  Media

• Recessed Lights Sold?

  Yes

  No

  N/A

• Recessed Lights- Put in the Number and the Fix Needed Halo Trim = HT. Juno Trim = JT. LED= CREE . RC= Replace Non-IC Can

• Basement

• 1st Floor

• Living Room

• Family room

• Kitchen/Nook

• Dining Room

• Butlers Pantry

• Study

• Powder Room

• Laundry/Mud Room

• Master Bedroom

• Master Bathroom

• Bedroom #1

• Bedroom #2

• Bedroom #3

• Hall Bath

• 2nd Floor

• Master Bedroom

• Master Bathroom

• Bedroom #1

• Bedroom #2

• Bedroom #3

• Hall Bath

• Jack & Jill Bath

• Rim Joist Spray Foam Sold?

  Yes

  No

  N/A

• Ln Ft.

• Rim Joist Notes

• Attic Insulation Sold?

  Yes

  No

  N/A

• Sq Ft and R-Value

• Location1

• Sq Ft. and R-Value

• Location2

• Attic Notes

• Furnace Tune Up Sold?

  Yes

  No

  N/A

• Furnace Tune Up Notes

• Anything else sold?

  Yes

  No

  N/A

• Other Sale Notes

• Health and Safety Concerns

• Upgrades Dates Preference