RETAP Energy Assessment Checklist

Assessment Number: RA____

FACILITY INFORMATION Date: _________

Facility Name _______________________________________

Address (Street, City, Zip) _______________________________________
_______________________________________
County _______________________________________
Website _______________________________________
SIC Code _______________________________________
Reason for Assessment _______________________________________
_______________________________________

Contact Name, Title _______________________________________

Phone Number _______________________________________
Fax Number _______________________________________
Email Address _______________________________________

Year built, history _______________________________________

Number of Buildings _______________________________________
Number of Floors _______________________________________
Additions, when added _______________________________________
Total Square Feet _______________________________________
Leased or Owned _______________________________________
Type of Construction (brick metal, concrete block, other) ________________
_____________________________________________________________
Type of Roofs (sloped, flat, other) __________________________________
Wall Insulation: Yes? (__) Type ____________________________ No? (__)
Roof Insulation: Yes? (__)Type ____________________________ No? (__)
Ceiling Heights ______________________________________________
Loading Docks & Doors __________________________________________

OPERATIONS

What does Facility do? ___________________________________________

Number of Employees ____________________________________________
Number of Occupants, if different ___________________________________
Operating Hours/Schedule? ________________________________________
School Year? Summer? Other? _____________________________________
Provide building layout drawings ____________________________________
List major equipment ______________________________________________
_______________________________________________________________
Large motors (number, size) ________________________________________
Swimming Pool (operating hours)? ___________________________________

Rev Oct 2009 1

 RETAP Energy Assessment Checklist

ELECTRICITY

Purchased from _______________________________________________

Provide copies of invoices for past 13 months ________________________
Number of meters _____________________________________________
Transformer Owned? ___________________________________________
Is State Sales Tax Paid? ________________________________________
Office Equipment (computers, printers, etc.) _________________________
Energy Star compliant? _________________________________________
Number of exit signs (incandescent, CFL, LED) _______________________
Electric Water Heaters (Number, size, location) _______________________
Water Heater Temperature Setting? ________________________________
Hot Water System Insulated? _____________________________________
Emergency Generator? __________________________________________
Number of lighted vending machines _______________________________
Timers for Coffeemakers? ________________________________________

LIGHTING

Number and types of lights in Facility, interior and exterior (include wattage,
length, ballast type and operating hours)

(Separate Tracking Form Provided for Lighting Count and Type)

Incandescent __________________________________________________
Fluorescent (T12, T8, T5) ________________________________________
Metal Halide __________________________________________________
Mercury Vapor _________________________________________________
Other ________________________________________________________

Occupancy Sensors? ____________________________________________

Timers for Security Lighting? ______________________________________
Photocell Controlled? _____________________________________________
Lamps/Ballasts Date-Stamped? ____________________________________
Group Relamping? ______________________________________________
Task Lighting at work areas? ______________________________________
Paint on Walls/Ceilings (white)? ____________________________________
Skylights/Windows (i.e. natural lighting)? _____________________________
Cleaning Crew Schedule? ________________________________________

Rev Oct 2009 2

 RETAP Energy Assessment Checklist

NATURAL GAS

Purchased from _______________________________________________

Provide copies of invoices for past 13 months ________________________
Is State Sales Tax Paid? ________________________________________
How/where is natural gas used? ___________________________________
How many meters? _____________________________________________
Gas Water Heaters (Number, size, location) __________________________
Hot water system insulated? ______________________________________
Water Heater Temperature Setting? ________________________________

HEATING and COOLING

General Description ____________________________________________

_____________________________________________________________
Is there an Energy Management System? ___________________________
Boilers? (size and rating) ________________________________________
• Chemically treated? _______________________________________
• Fuel-air ratio monitored? ___________________________________
• Energy Recovery system? __________________________________
• Dual-fueled? _____________________________________________
• Insulated? (tank & piping) ___________________________________
Chillers? Tonnage? _____________________________________________
Air-handling Units? ______________________________________________
Make-up Air? __________________________________________________
Roof Exhaust Fans? ____________________________________________
Unit Heaters? (type & number) ____________________________________
Types and location of thermostats __________________________________
Setpoint for Heating? _______________ Cooling? ____________________
Ceiling fans utilized? ____________________________________________
Type of windows (single-glazed, double-glazed) _______________________
Window area (square footage) _____________________________________
Condition of door seals, dock seals, etc. _____________________________
Single/Double Set of Exterior Doors? _______________________________
Air condensing coil? _____________________________________________
Cooling Tower? ________________________________________________
• Recirculation rate _________________________________________
• Manual or Automatic control _________________________________
• Chemical Supplier _________________________________________
• Treating water for bacteria? _________________________________

Rev Oct 2009 3

 RETAP Energy Assessment Checklist

WATER and SEWER

Purchased from _______________________________________________

Provide copies of invoices for past 13 months ________________________
Number and Size of Meter(s) _____________________________________
Potable, Non-Potable? __________________________________________
Wastewater Treatment (POTW, on-site WWTP, other) _________________
Well water available/used? _______________________________________
Rainwater Captured for Irrigation? _________________________________
Water conservation technologies (faucets, toilets, etc.)? ________________
Lawn Sprinkling System (metered?) ________________________________
Billed for Irrigation Water? ________________________________________

COMPRESSED AIR SYSTEM

Number of Compressors _________________________________________

Horsepower and CFM Rating _____________________________________
Operating Pressure/Range _______________________________________
Cycle Time (on/off) _____________________________________________
Operating Strategy (e.g. primary, standby, etc.) _______________________
_____________________________________________________________
Air Compressor Piping Looped? ___________________________________
Surge Tanks? _________________________________________________
Air Dryer? ____________________________________________________
Condensate Removal (e.g. steam trap, etc.)? ________________________
Lubricants Used (e.g. synthetic) ___________________________________
Source for Intake Air to Compressor? ______________________________
Heat Recovery for Exhaust Air? ___________________________________
Formal Leak Detection Program? __________________________________

Rev Oct 2009 4