Building Pre-Retrofit Evaluation Checklist

Building Pre-Retrofit Evaluation Checklist
Use this form to document an existing building’s current condition, systems, energy-related observations, and retrofit readiness before planning improvements.
Building Identification
Building Name
Street Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
City
State / Province
Postal Code
Building Type
Other
Year Built
Approximate Floor Area (sq ft)
Number of Stories
Primary Use / Occupancy
Occupancy and Contact Information
Contact Name
First NameMiddle NameLast Name
Role / Title
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Best Time to Contact
Hour Minutes
AM/PM Option
Current Occupancy Status
Typical Occupancy Hours
Number of Occupants or Units
Building Envelope and Site Conditions
Roof condition
Wall / facade condition
Window condition
Insulation visibility / known condition
Other
Air leakage concerns
Other
Foundation / basement condition
Signs of moisture intrusion
Other
Drainage / site water management condition

1
2
3
4
5
6
7
8
9
10
1 is Poor, 10 is Excellent
Exterior shading / exposure notes
Mechanical, Electrical, and Plumbing Systems
HVAC System Type
Heating Source
Cooling Type
Ventilation Type
Water Heating System
Lighting Type
Electrical Panel and Service Condition
Known Control Systems or Thermostats
Major Observed System Deficiencies
Energy Use and Retrofit Readiness
Available utility bills or energy data?
Recent fuel types used
Other
Known comfort issues
Other
Drafty areas
Other
Planned retrofit goals
Other
Constraints that may affect retrofit work
Priority areas for improvement
Additional energy use or retrofit readiness notes
Safety, Access, and Pre-Work Observations
Visible hazards observed
Other
Accessibility limitations
Other
Attic access available
Crawlspace access available
Basement access available
Special equipment needed
Other
Known environmental or material concerns
Additional safety, access, or pre-work observations
Checklist Summary and Follow-Up
Inspection Items Completed
Condition Rating by Major System
Rows Good Fair Poor Critical
Building Envelope
HVAC Systems
Electrical Systems
Plumbing Systems
Lighting
Controls and Automation
Safety and Life Safety
Overall Retrofit Priority

1
2
3
4
5
6
7
8
9
10
1 is Low Priority, 10 is High Priority
Recommended Follow-Up Studies or Tests
Other
Open Comments and Recommendations
Evaluator Signature
Powered by Jotform SignClear
Should be Empty:

Select theme:

Rows	Good	Fair	Poor	Critical
Building Envelope
HVAC Systems
Electrical Systems
Plumbing Systems
Lighting
Controls and Automation
Safety and Life Safety

Building Pre-Retrofit Evaluation Checklist

Building Identification

Occupancy and Contact Information

Building Envelope and Site Conditions

Mechanical, Electrical, and Plumbing Systems

Energy Use and Retrofit Readiness

Safety, Access, and Pre-Work Observations

Checklist Summary and Follow-Up