• Outside Relative Humidity:

  • Outside Air Temperature:

  • Day of the week

1.) Heating, ventilation, and air conditioning equipment in compliance with organization guidelines

  • Thermostat settings meet guidelines.

  • Building temperatures meet guidelines .

  • Fan coil units properly set-back.

  • Night/weekend/holiday set-back procedures followed per regulation 494-1.

  • Boiler/circulating pump operating times OK

  • Time clocks/EMS set correctly.

  • Vestibule/stairwell heaters turned to OFF at night.

  • Domestic hot water circulating pumps off during unoccupied times.

  • What are the enter and leave water temperatures for the boilers?

  • Boiler Temperatures
  • Enter water temperature:

  • Leave water temperature:

  • What are the enter and leave water temperatures for chiller?

  • Chiller Temperatures
  • Enter water temperature:

  • Leave water temperature:

  • Other

2.) Doors and windows:

  • Exterior/vestibule doors shut when heating/cooling in use.

  • Windows shut.

  • Instruction room doors shut when heating/cooling air in use.

  • Weather stripping okay.

  • Other

3.) Computers and peripherals:

  • Off at night.

  • Sleep mode during occupied.

  • Audio-visual equipment OFF

  • Other

4.) Lighting OFF in unoccupied:

  • Instruction rooms

  • Offices

  • Library

  • Dining area

  • Kitchen

  • Hallways

  • Lounges

  • Workrooms

  • Restrooms

  • Gymnasium

  • Locker rooms

  • Field houses

  • Stadium/press box

  • Storage rooms

  • Mechanical rooms

  • Custodian closets

  • Auditorium

  • Security lights/time clocks adjusted correctly

  • Other

5.) Plumbing/irrigation:

  • Organization's water guidelines being observed

  • Water fountains operating properly

  • Faucets operating properly

  • Commodes and urinals properly adjusted

  • Mechanical room plumbing OK

  • Cooling tower operating properly

  • Other

6.) Miscellanous:

  • Copiers, office equipment OFF

  • Exhaust fans OFF in non-critical areas

  • Logger data being collected.

  • Personal appliances?

  • Other

  • Energy Specialist

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.