Home Energy Scoring Tool
Data Collection Sheet
Assessment Date: _________________ Qualified Assessor: ______________________________ Comments: ________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Location Information Address: ________________________________ City: ________________ State: _____ Zip: ______
House Information Year Built: _______________ # of Bedrooms: __________ # of Stories Above Grade: ___________ Conditioned Floor Area (sq ft): _____________ Average Ceiling Height (ft): ____________ Direction Faced by Front of House: N / NE / E / SE / S / SW / W / NW
Air Tightness Air Leakage rate: _______________ cfm50 or Has the house been air sealed?: Yes / No
Roof Roof Construction: Standard Roof / with Radiant Barrier / with Expanded Polystyrene Sheathing (EPS) Exterior Finish: Composition Shingles or Metal / Wood Shake / Clay Tile / Concrete Tile / Tar & Gravel Insulation Level (on roof): R-0 / R-11 / R-13 / R-15 / R-19 / R-27 Roof Absorptance (number between 0.0 - 1.0): _________
Attic Attic or Ceiling Type: Unconditioned Attic / Conditioned Attic / Cathedral Ceiling Attic Floor Insulation: R0 / R-3 / R-6 / R-11 / R-19 / R-21 / R-25 / R-30 / R-38 / R-49 / R-60
Foundation Type: Slab-on-Grade / Unconditioned Basement / Conditioned Basement / Unvented Crawlspace / Vented Crawlspace Foundation Insulation: None / R-5 (slab only) / R-11 (bsmt/crawl wall) / R-19 (bsmt/crawl wall) Insulation over Basement or Crawlspace: R0 / R-11 / R-13 / R-15 / R-19 / R-21 / R-25 / R-30 / R-38 Skylights: Yes or No (circle one): Total Skylight Area (sq. ft.): _____________ Number of Panes: ___________
Frame Type: Aluminum / Aluminum with Thermal Break / Wood or Vinyl Glazing Type: Clear / Tinted / Solar Control low-E / Insulating low-E, argon gas fill
Wall Characteristics: Front or All (circle one) Construction: Wood Frame / Wood Frame with Expanded Polystyrene Sheathing (EPS) / Wood Frame with Optimum Value Engineering / Structural Brick / Concrete Block or Stone / Straw Bale Exterior Finish: Wood, Asbestos, Fiber Cement, Composite Shingle or Masonite Siding / Stucco / Vinyl Siding / Aluminum Siding / Brick Veneer / Asbestos Siding / Fiber Cement Siding / Composite Shingle Siding / Masonite Siding Wall Insulation: R-0 / R-3 / R-7 / R-11 / R-13 / R-15 / R-19 / R-21/ R-27 / R-33 / R-38
Window Area (sq. ft.): Front: __________ Right Side: ___________ Back: _________ Left Side: __________
Window Characteristics: Front or All (circle one) Number of Panes: ___________ Frame Type: Aluminum / Aluminum with Thermal Break / Wood or Vinyl
Glazing Type: Clear / Tinted / Solar Control low-E / Solar Control low-E, argon gas fill / Insulating low-E / Insulating low-E, argon gas fill Alternative Values: U-Factor (between 0.01-5): __________ SHGC (between 0-1): _____________
Wall Characteristics: Right Side (facing house) Construction: Wood Frame / Wood Frame with Expanded Polystyrene Sheathing (EPS) / Wood Frame with Optimum Value Engineering / Structural Brick / Concrete Block or Stone / Straw Bale Exterior Finish: Wood, Asbestos, Fiber Cement, Composite Shingle or Masonite Siding / Stucco / Vinyl Siding / Aluminum Siding / Brick Veneer / Asbestos Siding / Fiber Cement Siding / Composite Shingle Siding / Masonite Siding Wall Insulation: R-0 / R-3 / R-7 / R-11 / R-13 / R-15 / R-19 / R-21/ R-27 / R-33 / R-38
Home Energy Score Data Collection
Window Characteristics: Right Side (facing house) Number of Panes: ___________ Frame Type: Aluminum / Aluminum with Thermal Break / Wood or Vinyl
Glazing Type: Clear / Tinted / Solar Control low-E / Solar Control low-E, argon gas fill / Insulating low-E / Insulating low-E, argon gas fill Alternative Values: U-Factor (between 0.01-5): __________ SHGC (between 0-1): _____________
Wall Characteristics: Back Construction: Wood, Asbestos, Fiber Cement, Composite Shingle or Masonite Siding / Wood Frame with Expanded Polystyrene Sheathing (EPS) / Wood Frame with Optimum Value Engineering / Structural Brick / Concrete Block or Stone / Straw Bale Exterior Finish: Wood Siding / Stucco / Vinyl Siding / Aluminum Siding / Brick Veneer / Asbestos Siding / Fiber Cement Siding / Composite Shingle Siding / Masonite Siding Wall Insulation: R-0 / R-3 / R-7 / R-11 / R-13 / R-15 / R-19 / R-21/ R-27 / R-33 / R-38
Window Characteristics: Back Number of Panes: ___________ Frame Type: Aluminum / Aluminum with Thermal Break / Wood or Vinyl
Glazing Type: Clear / Tinted / Solar Control low-E / Solar Control low-E, argon gas fill / Insulating low-E / Insulating low-E, argon gas fill Alternative Values: U-Factor (between 0.01-5): __________ SHGC (between 0-1): _____________
Wall Characteristics: Left Side (facing house) Construction: Wood, Asbestos, Fiber Cement, Composite Shingle or Masonite Siding / Wood Frame with Expanded Polystyrene Sheathing (EPS) / Wood Frame with Optimum Value Engineering / Structural Brick / Concrete Block or Stone / Straw Bale Exterior Finish: Wood Siding / Stucco / Vinyl Siding / Aluminum Siding / Brick Veneer / Asbestos Siding / Fiber Cement Siding / Composite Shingle Siding / Masonite Siding Wall Insulation: R-0 / R-3 / R-7 / R-11 / R-13 / R-15 / R-19 / R-21/ R-27 / R-33 / R-38
Windows Characteristics: Left Side (facing house) Number of Panes: ___________ Frame Type: Aluminum / Aluminum with Thermal Break / Wood or Vinyl
Glazing Type: Clear / Tinted / Solar Control low-E / Solar Control low-E, argon gas fill / Insulating low-E / Insulating low-E, argon gas fill Alternative Values: U-Factor (between 0.01-5): __________ SHGC (between 0-1): _____________
Home Energy Score Data Collection
Heating System Heating System Type: None / Central Gas Furnace / Room (thru-the-wall) Gas Furnace / Propane Furnace / Oil Furnace / Electric Furnace / Electric Heat Pump / Electric Baseboard Heater / Gas Boiler / Oil Boiler
Heating System Efficiency: Year Installed: _____________________ or Efficiency Value (AFUE or HSPF): _______________
Cooling System: Cooling System Type: None / Central Air Conditioner / Room Air Conditioner / Heat Pump
Cooling System Efficiency: Year Installed: _____________________ or Efficiency Value (SEER or EER): ________________
Ducts Duct Location: Conditioned Space / Unconditioned Basement or Unvented Crawlspace / Vented Crawlspace / Unconditioned Attic / Unknown or Not Applicable Insulation: Yes / No Air Sealed: Yes / No
Hot Water: Fuel: Fuel Oil / Natural Gas / Electricity / Propane
Hot Water System Efficiency: Year Installed: _____________________ or Energy Factor (between 0-1): ________________ Does the boiler also provide domestic hot water?: No / Tankless Coil / Indirect Tank
Home Energy Score Data Collection
