Information

  • Site

  • Add location
  • Select date

  • Site

  • Date

  • Outside Air Temp/RH

  • Is the building Occupied or Unoccupied?

HVAC

  • Thermostat settings meet guidelines?

  • Building Temps meet guidelines?

  • Night/Weekend/Holiday Setback procedures followed?

  • Time clocks/EMS set correctly?

  • Time Clock/EMS operating properly?

  • Vestibule/Stairwell heaters OFF

  • Notes

DOORS & WINDOWS

  • Exterior/vestibule doors closed when HVAC on?

  • Windows closed when HVAC on?

  • Hallway/stairwell doors Closed

  • Instructional/Interior doors closed?

  • Window blinds/Shades CLOSED evening/weekend/extended breaks?

  • Weather Stripping Poor--Excellent

  • Notes

LIGHTING

  • Is the Lighting OFF in unoccupied:

  • Instructional Rooms

  • Library

  • Media Center

  • Offices

  • Hallways

  • Lounges/Workrooms

  • Bathrooms

  • Are EXHAUST FANS OFF?

  • Gymnasium

  • Locker Rooms

  • Are EXHAUST FANS OFF?

  • Auditorium

  • Cafeteria

  • Kitchen

  • Storage Rooms/Mechanical Rooms

  • Are the SECURITY LIGHTS set correctly?

  • Are INTERIOR safety/security lights ON or OFF.

  • Are EXTERIOR safety/security lights ON or OFF?

  • Are the PARKING LOT LIGHTS OFF?

  • Lighting Notes

COMPUTERS/PERIPHERALS/AV EQUIPMENT

  • Are Computers OFF: Night, weekends, extended breaks

  • Notes

  • Are Computers in SLEEP mode during Occupied time?

  • Are Computer Monitors/Speakers OFF when not in use?

  • Notes

  • Are SMART BOARDS OFF during unoccupied times?

  • Are SMART BOARDS in SLEEP mode when not in use during OCCUPIED times?

  • Are copiers/office equipment OFF?

  • Are there PERSONAL APPLIANCES present?

  • Notes

KITCHENS

  • Equipment OFF when not in use

  • Exhaust fans OFF when not needed

  • Are COOLERS/FREEZERS CONSOLIDATED during weekends and extended breaks?

  • Notes

PLUMBING

  • Are water fountains working properly?

  • Are faucets operating properly?

  • Are there any water/leak issues?

  • Notes

CONCLUSION/SUMMARY

  • Overall Compliance Level FAIR--EXCELLENT

  • General Observations/Notes

  • Photo

  • Photo

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  • Follow-up Items

  • Colleen Kartychak, Energy Specialist
    Ckartychak@westasd.org
    (412) 913-8407

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.