BUILDING SERVICES & LIGHTING QUESTIONNAIRE 2014

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

Photos

• Photo of front of unit

  Media

• Photo of any external doors

  Media

• Each Room in unit showing lighting

  Media

• Internal part of the air conditioning unit

  Media

• External part of the air conditioning unit

  Media

• Name plate of air conditioning unit

  Media

• Photo of anything relevant

  Media

HVAC System

• Whats best describes the system installed

  Select Central Heating ( no cooling) using air distribution Central Heating using water convectors Central Heating using water floor heating Constant Volume heating/cooling system Variable Volume heating/cooling system Duel Duct constant volume system Fan Coil System Flue forced air convection heaters Indoor Package VAV local heating/cooling No heating/cooling Split or multi split system water loop heat pump system

  • Central Heating ( no cooling) using air distribution
  • Central Heating using water convectors
  • Central Heating using water floor heating
  • Constant Volume heating/cooling system
  • Variable Volume heating/cooling system
  • Duel Duct constant volume system
  • Fan Coil System
  • Flue forced air convection heaters
  • Indoor Package VAV local heating/cooling
  • No heating/cooling
  • Split or multi split system
  • water loop heat pump system

• Is the unit a shell. (No heating and or lighting)

  Yes

  No

• Was HVAC System installed on or after 1998

  Yes

  No

• Has the unit been pressure tested, if so provide a copy of the test certificate

  Yes

  No

• Photo of certificate.

  Media

• Is there any other relevant information

• Photo of anything relevant

  Media

Cooling

• Which chillers/cooling type is used

  Air Cooled

  Water Cooled

  Remote Condenser (split system)

• What is the pack chiller capacity

  up to 100kw

  101-500kw

  501-750kw

  >750kw

  N/A

• Have you recently had ductwork or AHU leak testing done recently

  ductwork

  AHU

  Both

  Neither

• Is the heating/cooling system separately metered?

  Yes

  No

• What controls do the systems have

  Select Central Time Control Optimum start/stop control Localised time control (room/zone) Local temperature control (room/zone) Weather Compensation Control

  • Central Time Control
  • Optimum start/stop control
  • Localised time control (room/zone)
  • Local temperature control (room/zone)
  • Weather Compensation Control

• Is there any other relevant information

• Photo of anything relevant

  Media

Hot Water

• Is the hot water supply?

  Select Same as HVAC system Dedicated DHW Boiler Stand alone water boiler Instantaneous DHW system instantaneous Combi Heat pump District Heating

  • Same as HVAC system
  • Dedicated DHW Boiler
  • Stand alone water boiler
  • Instantaneous DHW system
  • instantaneous Combi
  • Heat pump
  • District Heating

• Is there hot water storage

  Yes

  No

• If yes, what capacity in litres ?

• If there is water storage, what insulation is there ?

  Loose jacket

  Factory insulated

  None fitted

• If fitted, what is the thickness of the insulation ?

• Is there any other relevant information ?

• Photo of anything relevant

  Media

Lighting/Controls

• What best describes the type of lighting installed

  Select Compact fluorescent High Pressure Mercury High Pressure Sodium Metal Halide T12 fluorescent T5 fluorescent T8 fluorescent LED

  • Compact fluorescent
  • High Pressure Mercury
  • High Pressure Sodium
  • Metal Halide
  • T12 fluorescent
  • T5 fluorescent
  • T8 fluorescent
  • LED

• What are the lighting controls

  Manual

  Photo Electric

• If photo electric, what is the switching

  Photo switching

  Photo dimming

• Is there any occupancy sensing on the lighting

  Select None Manual on/off Auto on dimmed Auto on/off Manual on/dimmed Manual on/auto off

  • None
  • Manual on/off
  • Auto on dimmed
  • Auto on/off
  • Manual on/dimmed
  • Manual on/auto off

• Is there any other relevant information ?

• Photo of anything relevant

  Media

Completed by

• Add signature

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