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Energy Check Pre-Audit Questionnaire
Please complete this form and we will give you a call to discuss.
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* Indicates required question
Client Name
*
Your answer
Physical Address
*
Your answer
Phone Number
*
Your answer
Email Address
Your answer
How long have you lived in the home?
*
Your answer
Year Built
Your answer
Square Footage
Your answer
Number of Occupants
Your answer
Number of Bedrooms
Your answer
House Type
*
Detached
Duplex
Quadplex
Town Home
Additions?
*
Yes
No
Stories
*
1
2
3
Split level
Type(s) of Heating
*
Furnace
Boiler
Heat Pump
Woodstove
Traditional fireplace
Gas fireplace
Space heater
Electrical baseboard
Other
Required
Type of Fuel Used
*
Gas
Electric
Wood
Propane
Kerosene
Oil
Other
Required
Combustion (Gas. Oil or Propane) Appliances:
*
Water heater
Furnace
Range
Oven
Space heater
Dryer
Other
NONE
Required
Foundation
Finished basement
Unfinished basement
Vented crawlspace
Unvented crawlspace
Slab
Basement/Crawl Space Concerns
Mold
Humidity
Condensation
Bulk moisture
Insulation
Attic
Full floored attic
Full unfloored attic
Finished attic with access to knee walls
Finished attic without access to knee walls
Vaulted ceilings
None
Attic Concerns
Bulk moisture
No insulation
Mold
Possible asbestos
Window Concerns
*
Cracked
Not sealed
Original
Replacement
NONE
Required
Door Concerns
*
Do not fit well
No weather stripping
None
Required
How did you hear about us?
*
Your answer
What is your primary motivation for getting a home energy audit?
*
Environmental (Reducing greenhouse gasses &/or consumption)
Comfort issues (too hot/cold? Moisture? IAQ?)
Utility bills (increase monthly savings)
Home inspection (to get an idea of how your house performs)
Get ROI and Payback Analysis
Indoor Air Quality
Required
Are there primary areas of concern? (Select all that apply)
Utility Bills Heating and Cooling System
Insulation
Attic Space
Unfinished Basement or Crawlspace
Appliances or Lighting
Windows and doors
Indoor Air Quality
Exterior Issues (ex. Roof)
Please let us know anything else you'd like to add to your home audit goals.
Your answer
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