Home Energy Retrofit Assessment Report
1. Homeowner Information
2. Property Details
3. Summary of Existing Conditions
| System/Component |
Description/Condition |
| Roof/Attic Insulation |
|
| Wall Insulation |
|
| Windows/Doors |
|
| Heating System |
|
| Cooling System |
|
| Water Heating |
|
| Lighting |
|
| Ventilation |
|
| Other |
|
4. Energy Consumption Overview
| Utility |
Annual Consumption |
Unit |
Annual Cost |
| Electricity |
|
kWh |
|
| Natural Gas |
|
m3 / therms |
|
| Other (specify) |
|
|
|
5. Identified Opportunities & Recommendations
-
Measure:
Current State:
Recommendation:
Estimated Savings:
Estimated Cost:
-
Measure:
Current State:
Recommendation:
Estimated Savings:
Estimated Cost:
6. Estimated Cost & Payback
| Measure |
Estimated Cost |
Estimated Annual Savings |
Payback Period (years) |
|
|
|
|
|
|
|
|
7. Additional Notes / Observations
8. Assessor Information
9. Signatures
| Name |
Signature |
Date |
| Homeowner |
|
|
| Assessor |
|
|