Home Energy Score – Data Collection Form
Demo Version

General Information

Year of Construction:

Number of Bedrooms:

Blower Door Test Completed? ☐ Yes ☐ No
Result from audit report:

Professionally Air Sealed? ☐ Yes ☐ No

Window Specs Available? ☐ Yes ☐ No

Outside

House Orientation

Orientation (E/W/N/S):

Stories:

Roof

Exterior Finish:

Color:

Walls

Same All Sides?☐ Yes ☐ No

Construction Type:

Exterior Finish:

Insulation Same?☐ Yes ☐ No

Windows

Same All Sides?☐ Yes ☐ No

Panes:

Frame:

Glazing:

Inside

Attic

Roof Type:

Insulation:

Air Sealed?☐ Yes ☐ No

Ducts Present?☐ Yes ☐ No

If yes: ☐ Insulated ☐ Sealed

Main Floor

Square Feet:

Ceiling Height:

Skylights?☐ Yes ☐ No

Windows Area:

Left:

Right:

Back:

Front:

Wall Insulation:

Upper Floor

Sq Ft:

Ceiling Ht:

Skylights?☐ Yes ☐ No

Windows Area:

Left:

Right:

Back:

Front:

Crawlspace

Insulation:

Ducts?☐ Yes ☐ No

If yes: ☐ Insulated ☐ Sealed

Basement

Conditioned?☐ Yes ☐ No

Sq Ft:

Ceiling Ht:

Windows:

Left:

Right:

Back:

Front:

Wall Insulation:

Mechanical Systems

HVAC Equipment

Type:

Heating Equipment Year/Efficiency:

Cooling Equipment Year/Efficiency:

Water Heater

Type:

Year/Serial Number:

PV (Solar Panels)

Installed?☐ Yes ☐ No

Age:

Orientation:

Number of Panels/Capacity: