Hospital Energy Efficiency Inspection Report

1. General Information

Hospital Name Address Date of Inspection Inspector Name(s)

2. Facility Profile

Total Floor Area (m²) Number of Beds Operating Hours

3. Energy Consumption Data

Energy Source	Annual Consumption	Unit	Comments
Electricity		kWh
Natural Gas		m³
Diesel		Litre
Other

4. Assessment of Major Energy-Using Systems

System	Observations	Condition	Opportunities
Lighting
HVAC
Hot Water
Medical Equipment
Other

5. Key Findings

6. Recommendations

7. Inspector Signature

Name Date Signature