Number range CHAPTER![](media/image3.wmf){width="1.5166666666666666in"
height="0.6715277777777777in"}

**Contact Information**

Agency:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Facility:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Audit
Title:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DOE Support Office
Representative:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Auditing
Firm:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Auditing Firm Contact (Name, Title, Address) Site Audit Coordinator
(Name, Title, Address)

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Phone\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Fax\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Phone\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Fax\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

E-mail
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
E-mail
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Congressional District\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Facility Contact (Name, Title, Address) Agency Contact (Name, Title,
Address)

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\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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Phone\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Fax\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Phone\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Fax\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

E-mail
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
E-mail
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Congressional District\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Congressional District\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**General Audit Information**

Audit Start Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Number of Buildings
Audited: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Audit Completion Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Total Square
Feet Audited: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Audit Report Submit Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Audit Cost: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Type of Audit Performed:

Agency Share of Cost (% or \$):\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \[ \]
SAVEnergy Survey

Audit Cost/Square Foot: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \[ \] Water
Conservation Survey

Renewable Energy Opportunities: \[ \] Site Data Package

Yes\_\_\_ No\_\_\_ Maybe\_\_\_ \[ \] Whole Building Computer Simulation

Water Conservation Opportunities: \[ \] Federal Energy Decision
Screening

Yes\_\_\_ No\_\_\_ Maybe\_\_\_ (FEDS) Analysis

Project Status: Complete\_\_\_ In Progress\_\_\_

**Performance of Auditor:**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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*Please submit audit summary to your DOE Regional Office representative*

**Page 1-3**

SAVEnergy Audit Summary

**Attachment 1 -- Summary Audit Data**

**Building Information**

Building type: (Select 1 category)

\[ \] Hospital Number of Buildings:\_\_\_\_\_\_\_\_\_\_ Square
Footage:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Housing-multi Number of Buildings:\_\_\_\_\_\_\_\_\_\_ Square
Footage:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Housing-single Number of Buildings:\_\_\_\_\_\_\_\_\_\_ Square
Footage:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Office Number of Buildings:\_\_\_\_\_\_\_\_\_\_ Square
Footage:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Industrial Number of Buildings:\_\_\_\_\_\_\_\_\_\_ Square
Footage:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Prison Number of Buildings:\_\_\_\_\_\_\_\_\_\_ Square
Footage:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] R&D Number of Buildings:\_\_\_\_\_\_\_\_\_\_ Square
Footage:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] School Number of Buildings:\_\_\_\_\_\_\_\_\_\_ Square
Footage:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Warehouse Number of Buildings:\_\_\_\_\_\_\_\_\_\_ Square
Footage:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Service Number of Buildings:\_\_\_\_\_\_\_\_\_\_ Square
Footage:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Other Number of Buildings:\_\_\_\_\_\_\_\_\_\_ Square
Footage:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Total Buildings:\_\_\_\_\_\_\_\_\_\_\_\_ Total Square
Feet:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Building Energy and Water Recommendations**

Energy Usage and Potential Savings

Energy Source Measured Usage/Yr Cost/Yr

\[ \] Natural Gas \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(ccf, mcf, or therms)
\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Electricity \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(kWh)
\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Fuel Oil \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(gallons of fuel)
\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Purchased Steam \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(million lb)
\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Propane \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(gallons of fuel)
\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Water \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(million gallons)
\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Other \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(Specify:\_\_\_\_\_\_\_\_\_)
\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Specify:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Energy Source Potential Usage Savings/Yr Potential Cost Savings/Yr

\[ \] Natural Gas \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(ccf, mcf, or therms)
\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Electricity \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(kWh)
\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Fuel Oil \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(gallons of fuel)
\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Purchased Steam \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(million lb)
\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Propane \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(gallons of fuel)
\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Water \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(million gallons)
\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Other \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(Specify:\_\_\_\_\_\_\_\_\_)
\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Specify:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Page 2-3**

**Recommended Energy Conservation Measures**

Savings Summary

+------------------+--------+--------+------+---------+-----+---------+
| Number range     | **     | **     |      |         | **  | **      |
| CHAPT            | Cost** | Annual |      |         | Sim | Savings |
| ER**Conservation |        | Sav    |      |         | ple | to      |
| Measure**        |        | ings** |      |         | P   | Inv     |
|                  |        |        |      |         | ayb | estment |
|                  |        | **D    |      |         | ack | Ratio** |
|                  |        | ollars |      |         | Pe  |         |
|                  |        | Energy |      |         | rio |         |
|                  |        | Commo  |      |         | d** |         |
|                  |        | dity** |      |         |     |         |
|                  |        |        |      |         | **  |         |
|                  |        | **     |      |         | (ye |         |
|                  |        | (MBtu) |      |         | ars |         |
|                  |        | (kWh,  |      |         | )** |         |
|                  |        | e      |      |         |     |         |
|                  |        | tc.)** |      |         |     |         |
+------------------+--------+--------+------+---------+-----+---------+
|                  |        |        |      |         |     |         |
+------------------+--------+--------+------+---------+-----+---------+
|                  |        |        |      |         |     |         |
+------------------+--------+--------+------+---------+-----+---------+
|                  |        |        |      |         |     |         |
+------------------+--------+--------+------+---------+-----+---------+
|                  |        |        |      |         |     |         |
+------------------+--------+--------+------+---------+-----+---------+
|                  |        |        |      |         |     |         |
+------------------+--------+--------+------+---------+-----+---------+
|                  |        |        |      |         |     |         |
+------------------+--------+--------+------+---------+-----+---------+
|                  |        |        |      |         |     |         |
+------------------+--------+--------+------+---------+-----+---------+
|                  |        |        |      |         |     |         |
+------------------+--------+--------+------+---------+-----+---------+

**Project Screening Criteria**

Select all that apply to the audited buildings

\[ \] Adequate solar access \[ \] Pilot Project

\[ \] Agency funds are available \[ \] Poor building conditions

\[ \] Aggressive DSM program \[ \] Need for project design assistance

\[ \] Aggressive utility program \[ \] Unique energy opportunities

\[ \] Building restrictions
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Champion at facility
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Potential showcase
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] Potential ESPC/Super ESPC delivery order

\[ \] History of energy conservation projects \[ \] Sensitivities

\[ \] Favorable electricity cost
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] High-profile building
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[ \] New construction (no A/E selected)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\* Please attach a page with any comments you may have concerning this
audit.

**Page 3-3**