Information

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Outside Relative Humidity:

  • Outside Air Temperature:

  • Day of the week

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 lowest setting at night.

  • Domestic hot water circulating pumps off during unoccupied times.

  • Mechanical rooms lights off.

  • Security lights/time clocks adjusted correctly

  • Exhaust fans OFF in non-critical areas

  • 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

Building Envelope

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

  • Windows shut.

  • Weather stripping and door sweeps okay.

  • Other

General Building

  • Hallway lights off.

  • Restroom lights off.

  • Lounge lights off.

  • Workroom lights off.

  • Storage rooms lights off.

  • Custodian closets lights off.

  • Copiers, office equipment OFF

  • Other.

Administration

  • Offices lights off.

  • Computers shutdown (except Wed and Thurs) and monitors off

  • Copiers, office equipment OFF

  • Other.

Library/Media Center

  • Library lights off.

  • Computers shutdown (except Wed and Thurs) and monitors off

  • Other.

Kitchen/Cafeteria/Multipurpose

  • Kitchen lights off.

  • Dining area lights off.

  • Exhaust fans and hoods off.

  • Other.

Classrooms

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

  • Lights off in unoccupied.

  • Computers shutdown (except Wed and Thurs) and monitors off

  • Audio-visual equipment OFF

  • Other.

Gym/Physical Education

  • Gymnasium lights off

  • Computers shutdown (except Wed and Thurs) and monitors off

  • Locker rooms lights off.

  • Other.

School grounds and fields

  • Other

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

Miscellaneous:

  • Logger data being collected.

  • Other
  • Other

  • Add media

  • 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. You should independently determine whether the template is suitable for your circumstances.