Energy Efficiency System Evaluation Checklist Form
Use this form to assess the performance and implementation status of an energy efficiency system and provide recommendations.
System Name or Reference
*
System Type
*
Please Select
HVAC
Lighting
Building Envelope
Industrial Process
Other
Current Operational Status
*
Fully Operational
Partially Operational
Not Operational
Implemented Energy Efficiency Measures (select all that apply)
Insulation Upgrades
Efficient Lighting
Controls/Automation
High-Efficiency Equipment
Renewable Integration
Other
Performance Compared to Baseline
*
1
2
3
4
5
How well are system controls/automation functioning?
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Controls are responsive
1
2
3
4
5
Automation reduces energy waste
6
7
8
9
10
Observed Issues or Barriers
Estimated Annual Energy Savings (%)
Areas for Improvement
Recommendations for Further Action
*
Submit Evaluation
Should be Empty: