close
lumiform
Lumiform Mobile audits & inspections
Get App Get App

Remain efficient with an energy audit form

Use this energy audits template checklist when conducting a basic energy audit and identify the energy consumed by a facility and locate energy conservation measures.

Downloaded 81 times
Part A - Company Details
Company Name
Company is LTD or PLC?
Company Registered Number
Registered or Head Office Address
Telephone Number
Website
Contact Name
Contact Position
Contact Email Address
Contact Direct Dial Number
How did the client hear about us?
Industry
Brief Description of Business Activities
Number of Employees
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.
Part B - Site Details
Site Information
Buildings On Site
Building/Unit Name
Current EPC/DEC Rating
Building Length (metres)
Building Width (metres)
Building Sq. Metreage
Number of Storeys
Ceiling Height (metres)
How many hours is the building occupied per day?
How many days is the building occupied per year?
What (if any) energy saving measures have already been recommended?
Have any of the measures above been completed?
Please detail the measures that have been completed
Heating
Type of fuel used
What is the price per litre?
No. of kWh used per month
Current fuel supplier
Are they in a contract?
Current contract period ends
Is the system vented or unvented?
Location of current boiler
Current boiler make
Current boiler model
Does the boiler provide heating and hot water or heating only?
Current heating delivery system
Current boiler output (kWh)
Describe the access to the boiler (internal and external)
Is there space available for an alternate heating source, i.e biomass?
Is there an existing flue system?
Please describe proposed route for flue
annotation!!!
Is a backup system required (if heat is used for manufacturing)?
Lighting
Lighting Location
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
Number of sensors recommended
Electrical
Current energy supplier is the same as heating fuel?
Current energy supplier
Are they in a contract?
When is the contract end 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?
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?
Glazing & Access
Are draft excluders fitted to all external doors?
Add entrance/exit with NO draft exclusion fitted
Area description
Type of glazing
Is there secondary glazing installed
Recommended replacement windows
Area
Height (mm)
Width (mm)
Frame replacement?
annotation!!!
Percentage of double glazing in property
Recommended replacement windows
Area
Height (mm)
Width (mm)
Frame replacement?
annotation!!!
Is energy saving glass installed (after 2002)?
Insulation
Type of wall construction
Is any wall insulation currently installed?
Is there scope to install wall insulation?
Insulation material used
Insulation thickness
Type of roof construction
Is there any roof insulation currently installed?
Is there scope to install roof insulation?
Insulation material used
Insulation thickness
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
annotation!!!
Is there space available for a ground mount solar PV system?
Width of area
Length of area
Sq. meterage of area
Distance to transformer
annotation!!!
Part C - Any Other Information
Is there any other relevant information for this site?
Other information
Place any pictures here
annotation!!!
Declaration
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
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
Share this template:

This post is also available in: Deutsch

Energy Audit Checklist Template: Improving Energy Efficiency in Your Business


An energy audit is an essential tool for identifying areas where energy consumption can be reduced, and efficiency improved in your business. A well-designed energy audit checklist template can help you to assess your energy use and identify potential energy-saving measures.


The Energy Audit Checklist Template covers a range of topics such as lighting, heating, ventilation, and air conditioning (HVAC) systems, building envelope, and energy management practices. It includes detailed questions and prompts to help you evaluate your energy use and identify potential areas for improvement.


Using this template can help you to reduce your energy costs, improve your operational efficiency, and reduce your carbon footprint. It can also help to ensure compliance with regulatory requirements and industry best practices.

Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
This site is registered on wpml.org as a development site. Switch to a production site key to remove this banner.