Energy Audit

• Energy Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Form to be completed by consultant only.
  

• Committente

• Indirizzo (sede legale)
  Address

• Telefono

• Email referente

• Azienda?

• Website

• Partita iva

• Nome referente

• Ruolo referente

• Contact Direct Dial Number

• Tipologia edificio/attività

• Breve descrizione dell'attività

• Number of Employees

  Select 1-10 10-20 20-40 40-60 60-100 100+

  • 1-10
  • 10-20
  • 20-40
  • 40-60
  • 60-100
  • 100+

• How did the client hear about us?

• Please note that this survey is to be kept confidential. Both consultant and client contact are to sign this document under the declaration section, acknowledging that all details herein are complete and correct to the best of their knowledge.

Informazioni sul sito

• Edifici / zone termiche

Edificio

• Nome edificio

• Uso

  Select residenziale uffici capannone produttivo capannone deposito negozio bar/ristorante scuola palestra

  • residenziale
  • uffici
  • capannone produttivo
  • capannone deposito
  • negozio
  • bar/ristorante
  • scuola
  • palestra

• Superficie edificio

• Numero di piani

  Select 1 2 3 4 5

  • 1
  • 2
  • 3
  • 4
  • 5

• Altezza netta interna

• Schema planimetrico

  Drawing

• Ore di occupazione giornaliere

• Quali interventi di risparmio energetico sono stati già raccomandati?

• Qualche intervento è stato completato?

  Off

  On

• Please detail the measures that have been completed

Involucro opaco

• Tipologia pareti

  muro portante in mattoni

  pareti a cassa vuota

  pannelli prefabbricati

  tamponamento non portante

• È presente uno strato isolante continuo?

• È possibile installare uno strato isolante

• Tipo di isolante presente

• Spessore isolante

• Tipologia copertura

  Select inclinata latrerocemento sottotetto inclinata legno inclinata eternit inclinata sandwich lastrico

  • inclinata latrerocemento
  • sottotetto
  • inclinata legno
  • inclinata eternit
  • inclinata sandwich
  • lastrico

• Is there any roof insulation currently installed?

• Is there scope to install roof insulation?

• Insulation material used

• Insulation thickness

Infissi

• Are draft excluders fitted to all external doors?

• Add entrance/exit with NO draft exclusion fitted

Entrance/exit

• Area description

• Type of glazing

  Select single glazing any double glazing wood double glazing aliminum double glazing PVC Triple Glazing PVC Triple glazing Aliminum

  • single glazing any
  • double glazing wood
  • double glazing aliminum
  • double glazing PVC
  • Triple Glazing PVC
  • Triple glazing Aliminum

• Is there secondary glazing installed

• Recommended replacement windows

Window

• Area

• Height (mm)

• Width (mm)

• Frame replacement?

• Quick design sketch (show openings)

  Drawing

• Percentage of double glazing in property

• Recommended replacement windows

Window

• Area

• Height (mm)

• Width (mm)

• Frame replacement?

• Quick design sketch of window design showing openings

  Drawing

• Is energy saving glass installed (after 2002)?

Riscaldamento

• Terminali

  Select radiatori ventilconvettori termoconvettori pavimento radiante soffitto radiante split aerotermi bocchette ad aria

  • radiatori
  • ventilconvettori
  • termoconvettori
  • pavimento radiante
  • soffitto radiante
  • split
  • aerotermi
  • bocchette ad aria

• Regolazione

  Select nessuna climatica (sonda esterna) 1 termostato termostati zone termostati ogni ambiente valvole termostatiche

  • nessuna
  • climatica (sonda esterna)
  • 1 termostato
  • termostati zone
  • termostati ogni ambiente
  • valvole termostatiche

• Generatori

Generatore

• Tipologia generatore

• Marca e modello generatore

• Potenza generatore (kWh)

• Does the boiler provide heating and hot water or heating only?

  heating only

  heating and hot water

• Tipo combustibile

  Select Gas naturale GPL Gasolio Energia Elettrica Pellet Cippato Legna

  • Gas naturale
  • GPL
  • Gasolio
  • Energia Elettrica
  • Pellet
  • Cippato
  • Legna

• What is the price per litre?

• Posizione generatore

• Describe the access to the boiler (internal and external)

• Is there space available for an alternate heating source, i.e biomass?

• No. of kWh used per month

• Current fuel supplier

• Giorni di occupazione annui

• Are they in a contract?

  Yes

  No

  N/A

• Current contract period ends

  Date

• Is a backup system required (if heat is used for manufacturing)?

Lighting

• Lighting Location

Area

• Location

• Number of fittings

• Height of fittings

• Fitting type

• Wattage per bulb

• Is the fitting a switch start fluorescent?

• Hours on per day

• Area usage in hours per day

• Recommended fitting type

  PIR sensors

  MCDB fittings

  LED Fittings

• Number of sensors recommended

Electrical

• Current energy supplier is the same as heating fuel?

• Current energy supplier

• Are they in a contract?

  Yes

  No

  N/A

• When is the contract end date?

  Date

• Annual usage (kWh)

• Current price per unit

• Location of main distribution board

• Location of main service head (origin)

• Is there half hourly data available on the energy bills?

• Is the supply 3 phase or single phase?

  3 phase

  single phase

• Total amps

• Total voltage

• Maximum demand

• MPAN Number

• Distribution board make

• Distribution model

• Spare fuse way in board?

• Voltage optimisation installed?

• Is there a backup generator?

External

• Is there a suitable elevation for solar panels?

• Length of elevation (metres)

• Width of elevation (metres)

• Height to guttering

• Angle of roof

• Angle from south

• Percentage shading

• Rough sketch of layout

  Drawing

• Is there space available for a ground mount solar PV system?

• Width of area

• Length of area

• Sq. meterage of area

• Distance to transformer

• Rough sketch of layout

  Drawing

• Sono necessari interventi di riqualificazione energetica

• Isolamento

• Cappotto esterno

• Isolamento interno pareti

• Isolamento copertura

• Sostituzione infissi

• Impianto

• Sostituzione generatore

• Ristrutturazione impianto

• Regolazione

• Fonti rinnovabili

• Altri interventi

• Is there any other relevant information for this site?

• Other information

• Place any pictures here

  Media

• Draw any sketches here

  Drawing

• I acknowledge that this form has been completed to the best of my knowledge and that all information contained within it is correct. I understand that all the information provided within this document is confidential and I will treat it as such

• Signed

  Sign

• I understand that all of the information contained within this report will be kept confidential and only those employed and contracted by CRT will have access to the data provided herein. I understand that signing this document DOES NOT in anyway form a contract or part thereof.

• Signed

  Sign