Job Information
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Customer Name
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Location
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Date
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Outdoor Temperature/ Humidity
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Reasons for visit
- Hot/ Cold Spots
- High Humidity
- Low Humidity
- Poor air quality/ allergies
- Excessive dust
- Strange Smell
- Moisture problems
- Noise
- High energy usage/ bills
- Rooms feel stuffy
- Other- See comments
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Number of Levels
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Conditioned Floor Area
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Conditioned Floor Volume
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Front Door Orientation
- North
- Northeast
- East
- Southeast
- South
- Southwest
- West
- Northwest
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Energy Sources
- Electric
- Natural Gas
- Propane
- Fuel Oil
- Solar
- Geothermal
Walkthrough
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Photograph exterior sides of the building capturing all windows and doors.
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Photograph main area and observations.
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Master Suite
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Room 1
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Room 2
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Room 3
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Room 4
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Room 5
Moisture Assessment
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Are there signs that walls allow water intrusion or are compromised?
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Are there signs that the roof is allowing water intrusion or is compromised?
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Are there signs that the grading around the building allows water intrusion?
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Are there signs that the condition of gutters and downspouts allow water intrusion?
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Are there signs that the crawlspace or basement has water intrusion?
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Is there an effective vapor barrier in the crawlspace?
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Are there signs that the HVAC or plumbing is leaking or draining improperly?
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Does there appear to be condensation or biological growth forming on any surfaces?
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Does there appear to be a vapor retarder on the warm side of the insulation?
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Is a functional whole house dehumidifier present?
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Noted Indoor Dewpoint
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Comments
Envelope Assessment
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Type of Wall Assembly
- Wood frame, brick exterior, gypsum or plaster interior
- Wood frame, vinyl exterior, gypsum or plaster interior
- Wood frame, stucco exterior, gypsum or plaster interior
- Wood frame, fiber cement exterior, gypsum or plaster interior
- Block, vinyl exterior, gypsum or plaster interior
- Block, brick exterior, gypsum or plaster interior
- Block, brick exterior, no interior finish
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Wall Insulation Rating
- R0
- R11
- R13
- R15
- R19
- >R19
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Type of Ceiling Assembly
- Finished under vented attic
- Finished under un-vented attic
- Finished under ceiling/ roof
- Finished under encapsulated attic
- Other
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Average Ceiling Insulation. Capture pictures if possible.
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Document whether penetrations in ceiling are sealed
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Document Attic Ventilation Strategy
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Type of Floor Assembly
- Over vented crawlspace
- Over open crawlspace
- Over sealed crawlspace
- Over finished basement
- Over unfinished basement
- Over encapsulated, conditioned crawlspace
- Over concrete slab
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Average Floor Insulation
- R0
- R11
- R13
- R15
- R19
- >R19
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Document whether penetrations in floor are sealed
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Document Crawlspace Ventilation Strategy
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Comments
Ventilation
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Is the fresh air ventilation system functional?
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Is fresh air controlled, filtered and conditioned?
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Is there a functional interlock between kitchen exhaust and make up ventilation?
Building Pressure
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Dominant Duct Leakage: HVAC systems running and all doors open. Building pressure WRT outdoors? (>3Pa)
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Worst Case Depressurization: All exhaust systems on. Building pressure WRT outdoors (Pa)
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During worst case depressurization was negative pressure observed in the Combustion Air Zone?
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With ALL HVAC systems running and doors CLOSED- Main area pressure WRT outdoors (Pa)
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With ALL HVAC systems running and doors CLOSED- Master Suite room pressure WRT main area (Pa)
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With ALL HVAC systems running and doors CLOSED- Room 2 room pressure WRT main area (Pa)
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With ALL HVAC systems running and doors CLOSED- Room 3 room pressure WRT main area (Pa)
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With ALL HVAC systems running and doors CLOSED- Room 4 room pressure WRT main area (Pa)
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With ALL HVAC systems running and doors CLOSED- Room 5 room pressure WRT main area (Pa)
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Comments
Combustion Safety
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Photograph water heater, fireplace and kitchen range
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Photograph combustion intakes and vent terminations on all fuel- fired appliances
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Does HVAC or water heater draw combustion air from the envelope?
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Perform combustion analysis on water heater if fuel- fired.
Blower Door and Thermal Imaging
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Verify all windows/ doors closed, chimney sealed off, mechanicals off
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Main area: Thermal imaging observations under slight depressurization.
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Master Suite: Thermal imaging observations
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Room 1: Thermal imaging observations
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Room 2: Thermal imaging observations
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Room 3: Thermal imaging observations
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Room 4: Thermal imaging observations
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Room 5: Thermal imaging observations
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Blower door test pressure (Pa)
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Blower door CFM/50
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Blower door ACH/50
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Comments
HVAC and Duct Leakage (To be used in addition to HVAC Full System Assessment form)
- HVAC System and Ductwork
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System Tag or Area Served
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Cooling Equipment Total Nominal Capacity Total (BTUH)
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Heating Equipment Total Nominal Capacity Total (BTUH)
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Type of Duct System
- All galvanized
- Combination galvanized/ flex
- Combination ductboard/ flex
- Plenum/ flex branch
- Other
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Are there balancing dampers on all branch ducts?
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Duct Insulation
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Verify HVAC system is off, and all registers and grilles are taped off.
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Duct leakage CFM's at 25 Pa
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Duct leakage %
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Perform heat load calculation on this zone using measured duct and envelope leakage numbers.
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Is nominal cooling capacity closely matched to cooling load?
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Is nominal heating capacity closely matched to heating load?
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Comments
Final Observations
Summary of Findings
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Overall Envelope Insulation Effectiveness
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Overall Envelope Air Leakage Rate
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Overall Duct Insulation Effectiveness
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Overall Duct Leakage Rate
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Overall Water/ Vapor Intrusion Effectiveness
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Overall Ventilation Effectiveness
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Overall Building Pressure Control
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Overall Room Pressure Control
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Overall HVAC Performance
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Overall Comfort Control
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Overall Humidity Control
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Overall Indoor Air Quality
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Comments