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Home Energy Report™ Checklist nachi.org/home-energy-report Page 1 of 2 Revision February 18, 2014 Property: Zip code: * _________________________________ Address: ___________________________________ City: ______________________________________ State: _____________________________________ Year built: * ________________________________ Residents: * Ages 0 to 5: _____ Ages 6 to 13: _____ Ages 14 to 64: _____ Ages 65 and over: _____ Local Energy Prices (defaulted or entered data): Electricity: _____________/ kilowatt-hour Piped natural gas: ______/ therm or 100 CF Liquid propane gas: ________/ gallon Fuel oil: _________________/ gallon Building Design: Front door faces: N, NE, E, SE, S, SW, W, NW Stories above ground level: 1, 2, 3, 4 Floor to ceiling height: ___________________ft. Heated/cooled floor area (sq ft): ________________ Foundation type: ____________________________ Attic type: conditioned or unconditioned Roof absorptance (.35 light to .90 dark) _________ Insulation: Found/floor insulated: Yes No N/A Insulation (R-value) of ceiling / attic floor: ________ Insulation R-value of roof or sheathing insulation under the roof covering materials: ___________ Wall insulation type and R-value: Front: _________________________________ Back: _________________________________ Left: __________________________________ Right: _________________________________ Airtightness: House has been air sealed? Yes No N/A Measured air leakage in cfm50: ____________ Skylights: Old / ENERGY STAR Estimated skylight area: ___________________sq ft Type of glass: _______________________________ * critical data Windows: Old / ENERGY STAR Front of House: Window type: _____________________________ Estimated window area: ___________sq ft Back of House: Window type: _____________________________ Estimated window area: ___________sq ft Left of House: Window type: _____________________________ Estimated window area: ___________sq ft Right of House: Window type: _____________________________ Estimated window area: ___________sq ft Appliances & Equipment: Clothes washer: Yes / No Old / ENERGY STAR Clothes dryer: Y/N: Elec. / Gas: Old / ENERGY STAR # of refrigerators: ______ Old / ENERGY STAR # of freezers: _______ Old / ENERGY STAR Water Heater: Old / ENERGY STAR Year purchased:_________________________ Fuel: __________________________________ Tank size: _________ gallons Tankless: ____ HVAC thermostat: Standard Programmable Heating Equipment: Old / ENERGY STAR Type/Fuel: ____________ Year purchased:______ Efficiency: ________________________________ Capacity: ___________________ BTU/hour Combustion Equipment: Flame rollout: _______________________________ Blocked chimney: ____________________________ Rust / corrosion: _____________________________ Vent connector problems: _____________________ Combustion hazards: _________________________ Cooling Equipment: Old / ENERGY STAR Type/Fuel: ____________ Year purchased:______ Efficiency: ________________________________ Capacity: ___________________ BTU/hour

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Page 1: Home Energy Report™ Checklist Energy...Passive solar features: Yes No Solar PV system: Yes No Solar water heater: Yes No Wind turbine: Yes No ... Solar water heater: Yes No Wind

Home Energy Report™ Checklist                                                                                                                                                                                     nachi.org/home-energy-report    

  Page 1 of 2 Revision February 18, 2014

Property: Zip code: * _________________________________ Address: ___________________________________ City: ______________________________________ State: _____________________________________ Year built: * ________________________________ Residents: * Ages 0 to 5: _____ Ages 6 to 13: _____ Ages 14 to 64: _____ Ages 65 and over: _____ Local Energy Prices (defaulted or entered data): Electricity: _____________/ kilowatt-hour Piped natural gas: ______/ therm or 100 CF Liquid propane gas: ________/ gallon Fuel oil: _________________/ gallon Building Design: Front door faces: N, NE, E, SE, S, SW, W, NW Stories above ground level: 1, 2, 3, 4 Floor to ceiling height: ___________________ft. Heated/cooled floor area (sq ft): ________________ Foundation type: ____________________________ Attic type: conditioned or unconditioned Roof absorptance (.35 light to .90 dark) _________ Insulation: Found/floor insulated: Yes No N/A Insulation (R-value) of ceiling / attic floor: ________ Insulation R-value of roof or sheathing insulation under the roof covering materials: ___________ Wall insulation type and R-value: Front: _________________________________ Back: _________________________________ Left: __________________________________ Right: _________________________________ Airtightness: House has been air sealed? Yes No N/A Measured air leakage in cfm50: ____________ Skylights: Old / ENERGY STAR Estimated skylight area: ___________________sq ft Type of glass: _______________________________ * critical data

Windows: Old / ENERGY STAR Front of House: Window type: _____________________________ Estimated window area: ___________sq ft Back of House: Window type: _____________________________ Estimated window area: ___________sq ft Left of House: Window type: _____________________________ Estimated window area: ___________sq ft Right of House: Window type: _____________________________ Estimated window area: ___________sq ft Appliances & Equipment: Clothes washer: Yes / No Old / ENERGY STAR Clothes dryer: Y/N: Elec. / Gas: Old / ENERGY STAR # of refrigerators: ______ Old / ENERGY STAR # of freezers: _______ Old / ENERGY STAR Water Heater: Old / ENERGY STAR Year purchased:_________________________ Fuel: __________________________________ Tank size: _________ gallons Tankless: ____ HVAC thermostat: Standard Programmable Heating Equipment: Old / ENERGY STAR Type/Fuel: ____________ Year purchased:______ Efficiency: ________________________________ Capacity: ___________________ BTU/hour Combustion Equipment: Flame rollout: _______________________________ Blocked chimney: ____________________________ Rust / corrosion: _____________________________ Vent connector problems: _____________________ Combustion hazards: _________________________ Cooling Equipment: Old / ENERGY STAR Type/Fuel: ____________ Year purchased:______ Efficiency: ________________________________ Capacity: ___________________ BTU/hour

Page 2: Home Energy Report™ Checklist Energy...Passive solar features: Yes No Solar PV system: Yes No Solar water heater: Yes No Wind turbine: Yes No ... Solar water heater: Yes No Wind

Home Energy Report™ Checklist                                                                                                                                                                                     nachi.org/home-energy-report    

  Page 2 of 2 Revision February 18, 2014

Thermal Distribution: Duct type: ___________ Ducts insulated: Yes No N/A Ducts sealed: Yes No N/A Duct leakage observed: _______________________ Pipe insulation: Yes No N/A Whole house fan: Yes No Interior Lights: Incand:___, CFL:___, LED:___, Mixed:___ Exterior Lights: Incand:___, CFL:___, LED:___, Mixed:___ Pool: Yes No Spa/Hot tub: Yes No Sump Pump: Yes No Well: Yes No OPTIONAL: Common Air Leakage Points: Crawlspace ________________________________ Sill plate ___________________________________ Outdoor faucet ______________________________ Dryer vent _________________________________ Doors ____________________________________ Windows __________________________________ Duct registers _______________________________ Attic hatch _________________________________ Chases ____________________________________ Recessed lights _____________________________ Dropped soffits ______________________________ Plumbing vent stacks _________________________ Kitchen exhaust fan __________________________ Electrical outlet _____________________________ Ducts _____________________________________ Moisture Problems: Yes / No _________________ __________________________________________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________

Standard Green MLS Features: Tankless water heater: Yes No Geothermal heat pump: Yes No Passive solar features: Yes No Solar PV system: Yes No Solar water heater: Yes No Wind turbine: Yes No Energy audit available: Yes No N/A Result: ___________________________________ HERS Rating: Yes No N/A Result: ___________________________________ Energy Star Qualified Home: Yes No N/A Result: ___________________________________ LEED Home: Yes No N/A InterNACHI Home Energy Inspection: Yes No N/A Result: ___________________________________ Builders challenge qualified: Yes No N/A NAHB green bldg program: Yes No N/A ANSI green bldg program: Yes No N/A Low-flow showerheads: Yes No Dual-flush toilets: Yes No High efficiency toilets: Yes No Home Energy Score: Yes No N/A Result: ___________________________________ Other ‘Green’ Features: There is an edible garden area. Yes No Drive/walks mostly permeable material. Yes No Exterior lights controlled by motion sensors. Yes No Deck made of composite/recycled material. Yes No Exterior doors close tightly. Yes No Crawlspace covered with a vapor barrier. Yes No Electronic or HEPA air filter installed. Yes No Return air registers in every bedroom. Yes No No faucets drip. Yes No __________________________________________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


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