Title Page

  • Client / Site

  • Conducted on

  • Prepared by

Equipment & Appliances

  • Instructions:

    1. Based on inspection, select whether an equipment or appliance is "efficient" or "inefficient".
    2. Include notes to explain your findings and recommendations to improve efficiency and reduce energy costs.

    Check lighting systems, HVAC Systems, and Electrical Appliances for energy efficiency, and recommend possible improvements to cut energy costs.

Lighting Systems - Internal

  • Floor plan (if available)

  • Waiting Zone

  • Reception

  • Kitchen

  • Cafe Lounge

  • Office A

  • Office B

  • Office C

  • File/Stock Room

  • Conference Room

  • IT/Support Office

  • Retreat/Break Room

  • Open Office A

  • Open Office B

  • Copy Center

  • Notes

Lighting Systems - External

  • Pole-mounted lights

  • Canopy lighting

  • Notes

Heating, Ventilation, and Air Conditioning (HVAC)

  • Air conditioner

  • Furnace

  • Notes

Electrical Appliances

  • Computer CPU

  • Computer monitor

  • Printer

  • Scanner

  • TVs

  • Refrigerator

  • Microwave

  • Coffee machine

  • Shredder

  • Notes

Office Composition

  • Check for insulation and proper sealing.

  • Windows

  • Doors

  • Walls

  • Notes

Energy Consumption Habits

  • Are computers turned off when not in use?

  • Are appliances unplugged when not in use?

  • Are some lights turned off in the daytime to take advantage of natural light?

  • Are external lights turned off during daylight hours?

  • Are lights turned off at the end of office hours?

  • Is an automatic thermostat installed and setup for efficiency?

  • Is solar panel installation an option?

  • Notes

Findings and Recommendations

  • Summary Report

  • Name and Signature of auditor

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.