Job Information

  • Customer Name

  • Location
  • Date

  • Outdoor Temperature/ Humidity

  • Reasons for visit

  • Number of Levels

  • Conditioned Floor Area

  • Conditioned Floor Volume

  • Front Door Orientation

  • Number of Occupants

  • Number of HVAC Systems

  • Energy Sources

Walkthrough

  • Photograph exterior sides of the building capturing all windows and doors.

  • Photograph main area and observations.

  • Master Suite

  • Room 1

  • Room 2

  • Room 3

  • Room 4

  • Room 5

Moisture Assessment

  • Are there signs that walls allow water intrusion or are compromised?

  • Are there signs that the roof is allowing water intrusion or is compromised?

  • Are there signs that the grading around the building allows water intrusion?

  • Are there signs that the condition of gutters and downspouts allow water intrusion?

  • Are there signs that the crawlspace or basement has water intrusion?

  • Is there an effective vapor barrier in the crawlspace?

  • Are there signs that the HVAC or plumbing is leaking or draining improperly?

  • Does there appear to be condensation or biological growth forming on any surfaces?

  • Does there appear to be a vapor retarder on the warm side of the insulation?

  • Is a functional whole house dehumidifier present?

  • Noted Indoor Dewpoint

  • Comments

Envelope Assessment

  • Type of Wall Assembly

  • Wall Insulation Rating

  • Type of Ceiling Assembly

  • Average Ceiling Insulation. Capture pictures if possible.

  • Document whether penetrations in ceiling are sealed

  • Document Attic Ventilation Strategy

  • Type of Floor Assembly

  • Average Floor Insulation

  • Document whether penetrations in floor are sealed

  • Document Crawlspace Ventilation Strategy

  • Comments

Ventilation

  • Number of bathroom exhaust fans. Include pictures of all fans and their terminations.

  • Number of kitchen exhaust fans. Include pictures of all fans and their terminations.

  • Number of mechanical fresh air intakes. Include pictures of their intake and connection inside.

  • Is the fresh air ventilation system functional?

  • Is fresh air controlled, filtered and conditioned?

  • Is there a functional interlock between kitchen exhaust and make up ventilation?

Building Pressure

  • Dominant Duct Leakage: HVAC systems running and all doors open. Building pressure WRT outdoors? (>3Pa)

  • Worst Case Depressurization: All exhaust systems on. Building pressure WRT outdoors (Pa)

  • During worst case depressurization was negative pressure observed in the Combustion Air Zone?

  • With ALL HVAC systems running and doors CLOSED- Main area pressure WRT outdoors (Pa)

  • With ALL HVAC systems running and doors CLOSED- Master Suite room pressure WRT main area (Pa)

  • With ALL HVAC systems running and doors CLOSED- Room 2 room pressure WRT main area (Pa)

  • With ALL HVAC systems running and doors CLOSED- Room 3 room pressure WRT main area (Pa)

  • With ALL HVAC systems running and doors CLOSED- Room 4 room pressure WRT main area (Pa)

  • With ALL HVAC systems running and doors CLOSED- Room 5 room pressure WRT main area (Pa)

  • Comments

Combustion Safety

  • Photograph water heater, fireplace and kitchen range

  • Photograph combustion intakes and vent terminations on all fuel- fired appliances

  • Does HVAC or water heater draw combustion air from the envelope?

  • Perform combustion analysis on water heater if fuel- fired.

Blower Door and Thermal Imaging

  • Verify all windows/ doors closed, chimney sealed off, mechanicals off

  • Main area: Thermal imaging observations under slight depressurization.

  • Master Suite: Thermal imaging observations

  • Room 1: Thermal imaging observations

  • Room 2: Thermal imaging observations

  • Room 3: Thermal imaging observations

  • Room 4: Thermal imaging observations

  • Room 5: Thermal imaging observations

  • Blower door test pressure (Pa)

  • Blower door CFM/50

  • Blower door ACH/50

  • Comments

HVAC and Duct Leakage (To be used in addition to HVAC Full System Assessment form)

    HVAC System and Ductwork
  • System Tag or Area Served

  • Cooling Equipment Total Nominal Capacity Total (BTUH)

  • Heating Equipment Total Nominal Capacity Total (BTUH)

  • Type of Duct System

  • Are there balancing dampers on all branch ducts?

  • Duct Insulation

  • Verify HVAC system is off, and all registers and grilles are taped off.

  • Duct leakage CFM's at 25 Pa

  • Duct leakage %

  • Perform heat load calculation on this zone using measured duct and envelope leakage numbers.

  • Is nominal cooling capacity closely matched to cooling load?

  • Is nominal heating capacity closely matched to heating load?

  • Comments

Final Observations

Summary of Findings

  • Overall Envelope Insulation Effectiveness

  • Overall Envelope Air Leakage Rate

  • Overall Duct Insulation Effectiveness

  • Overall Duct Leakage Rate

  • Overall Water/ Vapor Intrusion Effectiveness

  • Overall Ventilation Effectiveness

  • Overall Building Pressure Control

  • Overall Room Pressure Control

  • Overall HVAC Performance

  • Overall Comfort Control

  • Overall Humidity Control

  • Overall Indoor Air Quality

  • Comments

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.