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WARM Program Audit Form

Customer Info:

Name :

Address :

City :

State :

Zip Code :

Account Number :

Email :

Phone Number :

Work Number :

Other Number :

Auditor Name :

WARM

WARM PLUS

Multi-Family PLUS

Check all that apply :

Installed electric heat job

AC job (at least 2,000 kWh summer seasonal use to qualify for roof coat/window film, new AC units or shell measures with full audit required)

De facto/supplemental heat jobs (electric heat in lieu of or in addition to primary heat source; winter seasonal use of at least 2,000 kWh with full audit required)

Water Heat Job

Baseload Job

Used Default

When seasonal allowance cannot be used (customer does not have 6 bills based on actual meter readings within a year), use default spending guidelines. Please note: Costs associated with any health and safety issues may not exceed 50% of the seasonal spending allowance

Audit Date :	Job Complete Date :	Seasonal spending allowance :
Coordinate with Gas Utility Program? Yes No	State Weatherization $:	Baseload kWh:
Coordinate with Gas Utility Program: Yes No	Gas Utility $:	Summer Seasonal Use:
Referred to State or other programs: Yes No	Other Program	Winter Seasonal kWh:
Landlord Name:	Landlord Phone:

Directions :

Customer qualifies under PCAP? Customer enrolled within 12 months :

Yes

No

Eligibility Verification :

Yes

No

Household Income $ : PER YEAR

Verified By :

Date Verified :

Primary Source Of Income :

1.Employment

2.Public Assist

3.Pension/Retirement

4.Unemployment

5.Disability

99.Other

Head of household employment status :

1.Full-Time Employment (35 or more hours per week)

2.Part-Time Employment (34 or fewer hours per week)

3.Unemployed Worker

4.Retired

5.Homemaker

6.Student

99.Other

Demographic/Dwelling Information required by the PUC & entered in LEEN by contractors:

Refer to Procedures Manual for "Preparing for an Audit" Document (REMINDER: Plug in refrigerator monitoring devices)

1.Name of household member present at audit

2.Relationship to customer

0.Self

1.Spouse

2.Sibling

3.Parent

4.Relative

5.Non-Relative

6.Other

3.Customer's Date of Birth

4.Ethnic Origin

1.Caucasian/White

2.African American

3.Hispanic

4.Asian/Pacific Is

5.Native American

99.Multi-Racial

5.Number of Occupants

6.Number of Handicapped Occupants

7.Occupancy Type:

Age of Occupants

Under Age 19:

Ages 19 to 62:

Over 62:

LED bulbs are non-warranted. Install these bulbs in lights that are used and average of one (1) hour or more a day.

Your goal is to install as many LEDs as possible in each customer's home.

LED Replacement Wattage

LED Bulbs

LE 3	LE 4	LE 5	LE 7	LE 8	LE 9	LE 10	LE 14
8 Watt Flood	13 - 14 Watt Flood	17 Watt Flood	2.3 Watt Globe	3.5 Med-Base Torpedo	13-14 Watt Retrofit Kit	3-Way	10 Globe	Location

LED Replacement Wattage

LED Bulbs

LE 15	LE 16	LE 17	LE 18	LE 19	LE 20	LE 21	LE 22	LE 23
9-13 Watt Standard Bulb 450-799 Lumens	9-13 Watt Standard Bulb 800-1099 Lumens	9-13 Watt Standard Bulb 1100-1599 Lumens	3.7-4.8 Watt Candelabra 150-299 Lumens	3.7-4.8 Watt Candelabra 300-499 Lumens	3.7-4.8 Watt Candelabra 500-699 Lumens	6-8 Watt Standard Bulb 310-450 Lumens	6-8 Watt Standard Bulb 450-799 Lumens	6-8 Watt Standard Bulb 800-1099 Lumens	Location

Number of LED Bulbs Installed:

Refrigerators

Number of refrigerators used

Test all units five years or older. If any unit was not tested, please use a web-based database to determine annual usage.

Existing Refrigerator and Freezer Testing Data

kWh Guidelines for Replacement: Test units for as long as possible but factor the test results back to a one hour reading. In order to meet the daily minimum guidelines for replacement the kWh must reach the kWh/Hour Minimum listed below by the end of one hour of monitoring. If at any time during the first hour of monitoring the meter reaches the kWh/Hour Minimum, the tester will indicate that the refrigerator is likely to qualify for replacement.

To get KWH/Hour test results:

Divide total kWh recorded by the monitor, by the number of minutes that the monitor has been on. Your answer will be the number of kWhs consumed per minute. Multiply this by 60 minutes to get the kWh usage for one hour. This is shown by the formula below. (Refer to chart on page 4-54 of the Policy and Procedures Manual)

Total kWhs recorded by monitor = kWhs per minute x 60 minutes = kWh per one hour

Number of minutes monitored

Refrigerator Size	kWh/Hour Minimum	Replacement
15 cu ft or less	.08 kWh	15 cu ft
16 - 19 cu ft	.10 kWh	17 or 18 cu ft
20 - 21 cu ft	.11 kWh	21 cu ft
22 cu ft or larger	.12 kWh	20 - 25 cu ft

Ambient Air Temperature Immediately Surrounding the Refrigerator during Testing

5 degrees (or more) hotter than average	0.88 factor
Average annual temperature for room*	1.00 Factor
5 degrees (or more) cooler than average	1.13 Factor

*If not known
by customer, use 70 degrees F

Freezers

Number of freezers used

Existing Freezer Type	Existing Freezer Size	If existing one hour of use is:	Then
Chest	Less than 8 cf	Greater than .064 kWh	Replace existing unit
Chest	8.1 to 12.9 cf	Greater than .084 kWh	Replace existing unit
Chest	13 to 15.5 cf	Greater than .103 kWh	Replace existing unit
Chest	15.6 cf or larger	Greater than .154 kWh	Replace existing unit
Upright	Less than 10 cf	Greater than .074 kWh	Replace existing unit
Upright	10.1 to 12.9 cf	Greater than .103 kWh	Replace existing unit
Upright	13 to 15.5 cf	Greater than .123 kWh	Replace existing unit
Upright	15.6 or larger	Greater than .154 kWh	Replace existing unit

Comments: Utilize this space to
indicate readings for
additional
refrigerators/freezers
monitored in the
home.

Washer and Dryer Assessment

Electric Water Heating Assessment

Document water
heating issues here,
such as family runs
out of hot water,
tank rusted:

Are you going to:	Yes	No
Replace or add expansion tank
Replace Element(s)
Replace Thermostats
Flush Tank?
Add/replace pressure relief valve
Add/replace pressure relief pipe
Changed Wiring
Changed Breaker

Did you change the temperature?

Yes

No

If yes, set both elements to the same temperature.

Test location:

Existing Temp:

Adjusted Temp: (No lower than 125 degrees F)

Are you wrapping water pipes?

Yes

No

If so, # of linear ft for hot water:

1/2"

3/4"

If so, # of linear ft for cold water:

1/2"

3/4"

Location:

Is the customer using heat tape on exposed water pipes?

Yes

No

Comments:

Faucet Aerators & Shower heads

Are you installing faucet aerators?

Yes

No

If so, which?

Bath Aerator # installed?

Kitchen Aerator # installed?

Location:

Are you installing a shower head?

Yes

No

If so, which?

with swivel head # installed?

with shutoff # installed?

with out shutoff # installed?

handheld # installed?

Location:

Are there any other hot water leaks?

Yes

No

If yes, where?

Are you going to repair leaks?

Yes

No

If yes, where?

Cooling Assessment

Summer Seasonal Use: kWh

Cooling Load Reduction Measures: Summer Seasonal use of 2,000 kWh or more qualifies for roof coat/window film, ACs and/or shell measures if related to cooling.

Window Film: Are there any windows on the west, south and east that are not shaded in the summer during the hours of 9 AM and 4 PM?

Yes

No

Approximate total sq. footage of window film needed:

# and location of west facing windows to receive film:

# and location of south facing windows to receive film:

# and location of east facing windows to receive film:

Reflective Roof Coating:Is there any roof area that faces south and receives sun all day in the summer and is metal or roll roof material?

Yes

No

Install roof coat?

Yes

No

Approx sq. footage of roof, times 2 for 2 coats:

Are there other steps to reduce A/C use i.e., AC timers, Fans, Screens?

Yes

No

Will install:

Comments

Room AC units:Is the EER on the existing room AC 6 or lower as labeled, calculated or metered? If so, it can be replaced with an Energy Star rated unit, but the Summer Seasonal Use (kWh) must be 2,000 or more to replace 1 unit and 2,500 to replace 2 units and 3,000 to replace 3 units.

Replace AC?	Replace Filter?	Clean Filter?
Yes	Yes	Yes
Yes	Yes	Yes
Yes	Yes	Yes
Yes	Yes	Yes
Yes	Yes	Yes

What are the customer's window AC thermostat use habits?

Total number of AC units to be replaced?

Manufactured year for newest room AC unit present (only if insulation is installed):

House Photos

Attic

Choose Image

2nd Fl

Choose Image

Basement

Choose Image

1st Fl

Choose Image

AAccess	VVentilation
HRecessed heat producing device	01Other
DDropped soffit/ceiling/bulkhead	02Other
IExisting insulation	03Other
SStored Items	04Other
FFloor	05Other

Basement/Crawl Spaces/Mobile Home Belly

Basement Air Sealing:

Perimeter (doors, windows, rim joist, walls)

Ceiling

Ducts

Other

Decide if the basement and/or crawl space is inside/outside the thermal and pressure boundaries. Then decide if air sealing/insulation should be at the basement and/or crawl space perimeter or at ceiling.

Insulation:

Area	Location	Sq Ft	Existing Effective R Value	Add R	New Insulation Type	Comments (such as joists running lengthwise or widthwise - 16" or 24" joist bay size)
Floor/Crawl Space
Perimeter
Other
Belly

Install ground cover:

Yes

No

If so, sq ft installed:

Are there any kneewalls?

Yes

No

Are they air sealed or blocked at the joist bays?

Yes

No

If not, please block them!

Seal?

Yes

No

Insulation:

Heating

Cooling

Area	Location	Sq Ft	Existing Effective R Value	Add R	New Insulation Type	Comments
Unfloored Attic 1
Unfloored Attic 2
Unfloored Attic 3
Floored Attic 1
Floored Attic 2
Cathedral
Finished Attic
Kneewall Floored
Kneewall Unfloored
Slopes
Vertical Kneewall
Vertical Kneewall

Attic Ventilation

Ventilation Type	Proposed Additional Ventilation	Location	Comments
Roof Vent
Gable Vent
Soffit Vent
Ridge Vent

Comments:

Cantilever Overhangs

Are there cantilever overhangs?

Yes

No

Is the underside blocked with an impermeable air barrier?

Yes

No

Are floor joists bays blocked?

Yes

No

If no, please block these joist bays and insulate.

Area	Location	Sq Ft	Existing Effective R Value	Add R	New Insulation Type	Comments
Cantilever
Cantilever
Bay Window

Side Walls

Siding Type:

Wood

Asphalt

Stucco

Aluminum

Vinyl

Brick

other

Interior Wall Material:

Can side walls be insulated?

If not, why?

If yes, list the facing direction of the side walls you want to insulate

North sq ft

South sq ft

East sq ft

West sq ft

Document side wall issues such as weak walls, open cavities, electrical issues, etc:

Other Zones such as attached garage

Insulation:

Area	Sq Ft	Existing Effective R Value	Add R	New Insulation Type	Comments
Garage Ceiling
Garage to outside Observation (Check 1)		Visibly Connected	Semi-connected	Not Visibly Connected

Is garage connected to intermediate zones?

Yes

No

If yes, where?

Is garage isolated from the thermal envelope?

Yes

No

H&S issue in garage?

Yes

No

Other Zones (Porches, Bay Windows etc.)?

Air Leakage Testing

Step 1: Multiply # of occupants x 15 CFM = CFM needed for people (P) Number of Occupants: X

15 CFM = Total CFM for the people (P)

Step 2: Multiply the building volume x .35 ACH. Then divide by 60 minutes to get CFM Natural for the Building (B)

Floor (1st, 2nd, etc)	Width x	Length x	= Area (sq ft)	x Ceiling Height	= Volume	x .35 ACH	Divide by 60 mins	= CFM N (B)

Number of Stories above grade	N Factor
1	19
1.5	16.8
2	15.4
2.5	14.4
3	13.7

Number of Stories above Grade:

Step 3. Answer B:
Step 4. Enter P or B (larger # of the 2)
Step 5. Multiply by height corrected N Factor:
Step 6. Answer: This is your target BAS.
Step 7. Air sealing below this number means you MUST install mechanical ventilation. Multiply Target BAS by .70.

If unvented combustion appliances exist, don't air seal the home below 0.5 ACHn; however, always air seal the attic from the living space regardless of BAS or existing CFM50. Follow ASHRAE62.89 and the Air Sealing Procedure in the WARM Manual.

				Pressures
	Thermal Boundary: In or Out?		What was blower door set at?		House/Zone		Zone/Outside

Pressure Pan Test Results (test at -25 Pascals) Duct leaks or disconnects observed?

Yes

No

Existing Duct Materials:

Metal

Ductboard

Flex

System Type:

Heat Pump

Central Air Only

Electric Furnace

other

Register

#1

#2

#3

#4

#5

#6

#7

#8

Room

Reading

Pre

Post

Pre

Post

Pre

Post

Pre

Post

Pre

Post

Pre

Post

Pre

Post

Pre

Post

Supply

Return

Note: Number registers by floor going away from Air Handler Unit (AHU). Register #1 will always be the one closest to AHU.

Copy this page for as many tests that are needed. Typically, there should be two of this form, one for pre-work testing and one for post-work testing.

Pre-Test

Post-Test

Tech Name

Auditor

Crew

Test Date:

Combustion Safety Testing

Are there Combustion Appliances?

Yes

No

Combustion Equipment Safety Tests must be performed if any air sealing will be done or is done. If post-treatment blower door test is lower than the pre-treatment test, the chart below MUST be completed. Refer to the Procedure Manual for complete testing procedure.

Are there any unvented combustion heating appliances?

Yes

No

	CO Initial Reading		CO After 5-10 Min		Optional
Appliance	AMB	CAZ	AMB	CAZ	Stack Temp	O2	Eff.
Water Heater
Furnace/Boiler
Gas Range
Other

*Calculate combustion air requirement in the case where there is spillage at one minute (Y) or where the draft pressure test fails (N). The standard method for calculating the required CAZ volume to provide sufficient air is 50 cubic ft for every 1,000 BTUH of combined appliance input.

Total BTUH

input / 1,000 x 50 = the cu. ft. volume of combustion air required.

Burners:

Write in visual inspection results for each burner (i.e. OK, Adjust, Clean).

Oven

If CO at oven vent is 225 ppm or more, install CO alarm and recommend service. No air sealing is allowed until CO level drops below 225 ppm.

Oven:

CO Ambient:

CO at oven vent:

AMB = Ambient, CAZ = Combustion Appliance Zone, Det = Detected, W/C = Worst Case Conditions, NAT = Natural, Temp = Temperature, Eff = Efficiency C

Pa = Pascal, IWC = Inches of Water Column: 50 Pa. = .2 IWC, 25 Pa. = .1 IWC, 1 Pa. = 0.00401 IW

CO Thresholds for Fossil-Fuel Fired Combustion Appliances

Appliance Threshold Limit

Central Furnace (all categories) - 400 ppm air free
Boiler - 400 ppm air free
Floor Furnace - 400 ppm air free
Gravity Furnace - 400 ppm air free
Wall Furnace (BIV) - 200 ppm air free
Wall Furnace (Direct Vent) - 400 ppm air free
Vented Room Heater - 200 ppm air free
Unvented Room Heater - 200 ppm air free
Water Heater - 200 ppm air free
Oven/Broiler - 225 ppm as measured
Clothes Dryer - 400 ppm air free
Refrigerator 25 ppm as measured
Gas Log (gas fireplace) 25 ppm as measured in vent
Gas Log (installed in wood burning fireplace) - 400 ppm air free in firebox

CAZ Worse Case Depressurization:

Natural:

WC:

Diff:

Emergency situation. Gas company called to fix gas leak or other.

Work cannot continue due to one or more failed tests over Action Level.

Select Appliances on
At Worst Case Test:

Dryer

Bath Fan

Kitchen Fan

Attic Fan

Whole House Fan

HVAC Air Handler

Notes:

Copy this page for as many tests that are needed. Typically, there should be two of this form, one for pre-work testing and one for post-work testing.

Pre-Test

Post-Test

Tech Name

Auditor

Crew

Test Date:

Combustion Safety Testing

Are there Combustion Appliances?

Yes

No

Combustion Equipment Safety Tests must be performed if any air sealing will be done or is done. If post-treatment blower door test is lower than the pre-treatment test, the chart below MUST be completed. Refer to the Procedure Manual for complete testing procedure.

Are there any unvented combustion heating appliances?

Yes

No

	CO Initial Reading		CO After 5-10 Min		Optional
Appliance	AMB	CAZ	AMB	CAZ	Stack Temp	O2	Eff.
Water Heater
Furnace/Boiler
Gas Range
Other

*Calculate combustion air requirement in the case where there is spillage at one minute (Y) or where the draft pressure test fails (N). The standard method for calculating the required CAZ volume to provide sufficient air is 50 cubic ft for every 1,000 BTUH of combined appliance input.

Total BTUH

input / 1,000 x 50 = the cu. ft. volume of combustion air required.

Burners:

Write in visual inspection results for each burner (i.e. OK, Adjust, Clean).

Oven

If CO at oven vent is 225 ppm or more, install CO alarm and recommend service. No air sealing is allowed until CO level drops below 225 ppm.

Oven:

CO Ambient:

CO at oven vent:

AMB = Ambient, CAZ = Combustion Appliance Zone, Det = Detected, W/C = Worst Case Conditions, NAT = Natural, Temp = Temperature, Eff = Efficiency C

Pa = Pascal, IWC = Inches of Water Column: 50 Pa. = .2 IWC, 25 Pa. = .1 IWC, 1 Pa. = 0.00401 IW

CO Thresholds for Fossil-Fuel Fired Combustion Appliances

Appliance Threshold Limit

Central Furnace (all categories) - 400 ppm air free
Boiler - 400 ppm air free
Floor Furnace - 400 ppm air free
Gravity Furnace - 400 ppm air free
Wall Furnace (BIV) - 200 ppm air free
Wall Furnace (Direct Vent) - 400 ppm air free
Vented Room Heater - 200 ppm air free
Unvented Room Heater - 200 ppm air free
Water Heater - 200 ppm air free
Oven/Broiler - 225 ppm as measured
Clothes Dryer - 400 ppm air free
Refrigerator 25 ppm as measured
Gas Log (gas fireplace) 25 ppm as measured in vent
Gas Log (installed in wood burning fireplace) - 400 ppm air free in firebox

CAZ Worse Case Depressurization:

Natural:

WC:

Diff:

Emergency situation. Gas company called to fix gas leak or other.

Work cannot continue due to one or more failed tests over Action Level.

Select Appliances on
At Worst Case Test:

Dryer

Bath Fan

Kitchen Fan

Attic Fan

Whole House Fan

HVAC Air Handler

Notes:

Copy this page for as many tests that are needed. Typically, there should be two of this form, one for pre-work testing and one for post-work testing.

Pre-Test

Post-Test

Tech Name

Auditor

Crew

Test Date:

Combustion Safety Testing

Are there Combustion Appliances?

Yes

No

Combustion Equipment Safety Tests must be performed if any air sealing will be done or is done. If post-treatment blower door test is lower than the pre-treatment test, the chart below MUST be completed. Refer to the Procedure Manual for complete testing procedure.

Are there any unvented combustion heating appliances?

Yes

No

	CO Initial Reading		CO After 5-10 Min		Optional
Appliance	AMB	CAZ	AMB	CAZ	Stack Temp	O2	Eff.
Water Heater
Furnace/Boiler
Gas Range
Other

*Calculate combustion air requirement in the case where there is spillage at one minute (Y) or where the draft pressure test fails (N). The standard method for calculating the required CAZ volume to provide sufficient air is 50 cubic ft for every 1,000 BTUH of combined appliance input.

Total BTUH

input / 1,000 x 50 = the cu. ft. volume of combustion air required.

Burners:

Write in visual inspection results for each burner (i.e. OK, Adjust, Clean).

Oven

If CO at oven vent is 225 ppm or more, install CO alarm and recommend service. No air sealing is allowed until CO level drops below 225 ppm.

Oven:

CO Ambient:

CO at oven vent:

AMB = Ambient, CAZ = Combustion Appliance Zone, Det = Detected, W/C = Worst Case Conditions, NAT = Natural, Temp = Temperature, Eff = Efficiency C

Pa = Pascal, IWC = Inches of Water Column: 50 Pa. = .2 IWC, 25 Pa. = .1 IWC, 1 Pa. = 0.00401 IW

CO Thresholds for Fossil-Fuel Fired Combustion Appliances

Appliance Threshold Limit

Central Furnace (all categories) - 400 ppm air free
Boiler - 400 ppm air free
Floor Furnace - 400 ppm air free
Gravity Furnace - 400 ppm air free
Wall Furnace (BIV) - 200 ppm air free
Wall Furnace (Direct Vent) - 400 ppm air free
Vented Room Heater - 200 ppm air free
Unvented Room Heater - 200 ppm air free
Water Heater - 200 ppm air free
Oven/Broiler - 225 ppm as measured
Clothes Dryer - 400 ppm air free
Refrigerator 25 ppm as measured
Gas Log (gas fireplace) 25 ppm as measured in vent
Gas Log (installed in wood burning fireplace) - 400 ppm air free in firebox

CAZ Worse Case Depressurization:

Natural:

WC:

Diff:

Emergency situation. Gas company called to fix gas leak or other.

Work cannot continue due to one or more failed tests over Action Level.

Select Appliances on
At Worst Case Test:

Dryer

Bath Fan

Kitchen Fan

Attic Fan

Whole House Fan

HVAC Air Handler

Notes:

Copy this page for as many tests that are needed. Typically, there should be two of this form, one for pre-work testing and one for post-work testing.

Pre-Test

Post-Test

Tech Name

Auditor

Crew

Combustion Safety Testing

Are there Combustion Appliances?

Yes

No

Combustion Equipment Safety Tests must be performed if any air sealing will be done or is done. If post-treatment blower door test is lower than the pre-treatment test, the chart below MUST be completed. Refer to the Procedure Manual for complete testing procedure.

Are there any unvented combustion heating appliances?

Yes

No

	CO Initial Reading		CO After 5-10 Min		Optional
Appliance	AMB	CAZ	AMB	CAZ	Stack Temp	O2	Eff.
Water Heater
Furnace/Boiler
Gas Range
Other

*Calculate combustion air requirement in the case where there is spillage at one minute (Y) or where the draft pressure test fails (N). The standard method for calculating the required CAZ volume to provide sufficient air is 50 cubic ft for every 1,000 BTUH of combined appliance input.

Total BTUH

input / 1,000 x 50 = the cu. ft. volume of combustion air required.

Burners:

Write in visual inspection results for each burner (i.e. OK, Adjust, Clean).

Oven

If CO at oven vent is 225 ppm or more, install CO alarm and recommend service. No air sealing is allowed until CO level drops below 225 ppm.

Oven:

CO Ambient:

CO at oven vent:

AMB = Ambient, CAZ = Combustion Appliance Zone, Det = Detected, W/C = Worst Case Conditions, NAT = Natural, Temp = Temperature, Eff = Efficiency C

Pa = Pascal, IWC = Inches of Water Column: 50 Pa. = .2 IWC, 25 Pa. = .1 IWC, 1 Pa. = 0.00401 IW

CO Thresholds for Fossil-Fuel Fired Combustion Appliances

Appliance Threshold Limit

Central Furnace (all categories) - 400 ppm air free
Boiler - 400 ppm air free
Floor Furnace - 400 ppm air free
Gravity Furnace - 400 ppm air free
Wall Furnace (BIV) - 200 ppm air free
Wall Furnace (Direct Vent) - 400 ppm air free
Vented Room Heater - 200 ppm air free
Unvented Room Heater - 200 ppm air free
Water Heater - 200 ppm air free
Oven/Broiler - 225 ppm as measured
Clothes Dryer - 400 ppm air free
Refrigerator 25 ppm as measured
Gas Log (gas fireplace) 25 ppm as measured in vent
Gas Log (installed in wood burning fireplace) - 400 ppm air free in firebox

CAZ Worse Case Depressurization:

Natural:

WC:

Diff:

Emergency situation. Gas company called to fix gas leak or other.

Work cannot continue due to one or more failed tests over Action Level.

Select Appliances on
At Worst Case Test:

Dryer

Bath Fan

Kitchen Fan

Attic Fan

Whole House Fan

HVAC Air Handler

Notes:

House Air Sealing

		UI/Lin. Ft/#	Location(s)	Materials	Labor Hrs
Doors:
Replace	Repair
Weatherstrip
Sweep(s)
Threshold(s)
Sealing
Windows:
Replace	Repair
Replace broken glass
Reglaze
Weatherstrip
Sash lock(s)
Sealing
Other:
Dryer/Other Vents
Fireplace
Plumbing
Electrical
Walls
Stairs
Other

Attics Indicate areas where air sealing is needed and/or performed:

Air Sealing Measures:	Materials	Labor hrs Optional
Top Plates
Plumbing Penetrations
Electrical Penetrations
Dropped Ceilings
Bulkhead soffits
Recessed fixtures
Access
Ducts
AC or htg system air handler
Open Chaseways
Other

Notes:

An additional 3 blower door tests may be performed to verify a continuous and effective pressure boundary (total of 5 per audit: 1 pre-work, 1 post-work and 3 for pressure boundary verification). Please record additional tests below.

Additional Zone Pressure Tests
WRT ---- >		House to Outside		House to Zone		Zone to House
Date	Zones	Pre-Wx	Post-WX	Pre-Wx	Post-WX	Pre-Wx	Post-WX





	Example:
03/21/19	Attic	-50	-50	-40	-50	-10	0

Horizontal attic access - insulate to at least equivalent R value of surrounding surfaces	Already done Will do Location: Weather Stripping Existing Add # of accesses existing: # of accesses to be added:
Vertical openings - insulate to equivalent R value of surrounding surfaces	Already done Will do Location: Weather Stripping Existing Add
Pull down stairs - insulate to at least equivalent R value of surrounding surfaces	Already done Will do Location: Weather Stripping Existing Add
Be sure to dam the access if it will remain operable.	Recommended? Yes No
Heat Producing Fixtures
Are there recessed heat producing fixtures?	Yes No
How many recessed fixtures are there?	# of lights # of fans # other
If you are going to insulate the attic floor or air seal the fixtures, please continue.
How many are IC rated? How many are non-IC rated? How many have an unknown rating?
How many will be dammed to protect them from insulation? How many will be air sealed either with sealed dams or with air tight inserts?
Will customer allow recessed light(s) to be changed out? Yes No
How many will be replaced with either air tight, IC rated recessed fixtures, or surface mounted fixtures?
How many are under the floored attic and protected with metal dam blocking or fiberglass batt blocking?
When complete, the recessed fixtures must not leak air into the attic and dams must be able to be seen from the attic unless they are under the attic floor.
Be sure to dam any chimney flues.	Recommended? Yes No # of chimneys:

Zones	In	Out	Pre-Treat	Final	Pre-Treat	Final	Pre-Treat	Final
Attic
Basement
Vented Crawl
Attic A
Attic B
Kneewall A
Kneewall B
Cantilever Overhang
Garage Attic
Garage (45pa or less proceed below)
Garage Door Closed/Open Testing	CFM 50 Open		CFM 50 Closed		CFM 50 Difference		% Diff (CFM 50 Diff/CFM 50 CL)*100
(Section 4-69) Value (Pre/Post)

Vendor Management

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Quick Links

WARM Program Audit Form

Customer Info:

Demographic/Dwelling Information required by the PUC & entered in LEEN by contractors:

Refer to Procedures Manual for "Preparing for an Audit" Document (REMINDER: Plug in refrigerator monitoring devices)

Customer Interview (Introduce the Partnership Concept)

Customer Interview

LED Night Lights - Smart Power Strips - Furnace Whistles - CO Alarms -

Act 129

LED bulbs are non-warranted. Install these bulbs in lights that are used and average of one (1) hour or more a day.

Your goal is to install as many LEDs as possible in each customer's home.

LED Replacement Wattage

LED Bulbs

LED Replacement Wattage

LED Bulbs

Refrigerators

Existing Refrigerator and Freezer Testing Data

To get KWH/Hour test results:

Ambient Air Temperature Immediately Surrounding the Refrigerator during Testing

Water Mark

Primary refrigerator:

Secondary Refrigerator:

Water Mark

Additional Refrigerator:

Freezers

Primary Freezer:

Secondary Freezer:

Additional Freezer:

Washer and Dryer Assessment

Dryer venting details:

Semi-Rigid Aluminum Flex used. Why?

Electric Water Heating Assessment

Faucet Aerators & Shower heads

Other

Heat Pump Water Heater (HPWH)

Date

Cooling Assessment

Duct work Sealing and/or Duct Installation: Are there obvious duct leaks in any duct work that is outside the thermal boundary?

Date

Electric Heat:

Fossil Fuel Heating Assessment

Structure Assessment

If the blower door test indicates air sealing is to be performed, indicate location of air leaks.

Mechanical Ventilation

Kitchen:

Floor Bathrooms:

Floor Bathrooms:

House Photos

Attic

2nd Fl

Basement

1st Fl

Basement/Crawl Spaces/Mobile Home Belly

Basement Air Sealing:

Insulation:

Attic Ventilation

Attic Access:

Cantilever Overhangs

Side Walls

Other Zones such as attached garage

Insulation:

Air Leakage Testing

Check all that apply:

Combustion Safety Testing

Burners:

Oven

Oven:

AMB = Ambient, CAZ = Combustion Appliance Zone, Det = Detected, W/C = Worst Case Conditions, NAT = Natural, Temp = Temperature, Eff = Efficiency C

Pa = Pascal, IWC = Inches of Water Column: 50 Pa. = .2 IWC, 25 Pa. = .1 IWC, 1 Pa. = 0.00401 IW

CO Thresholds for Fossil-Fuel Fired Combustion Appliances

Select Appliances on At Worst Case Test:

Combustion Safety Testing

Burners:

Oven

Oven:

AMB = Ambient, CAZ = Combustion Appliance Zone, Det = Detected, W/C = Worst Case Conditions, NAT = Natural, Temp = Temperature, Eff = Efficiency C

Pa = Pascal, IWC = Inches of Water Column: 50 Pa. = .2 IWC, 25 Pa. = .1 IWC, 1 Pa. = 0.00401 IW

CO Thresholds for Fossil-Fuel Fired Combustion Appliances

Select Appliances on
At Worst Case Test:

Select Appliances on
At Worst Case Test:

Select Appliances on
At Worst Case Test:

Select Appliances on
At Worst Case Test: