*Responses to all questions are required in order to produce your energy-saving recommendations. |
Home Information |
1. Year your house was built: |
Before 1960
1960 – 1969
1970 – 1979
1980 – 1989
1990 – 1994
1995 – 1999
2000
– 2004
After 2004 |
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2. Type of dwelling |
Single-family
Modular
Mobile, manufactured home
Apartment, duplex, condo |
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3. House type: (any that apply) |
1-level ranch
2+ stories
Split-level
Basement
Single-wide
Double-wide
Triple-wide |
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4. Size of home: |
Less than 1,000
1,000 - 1,499
1,500 - 1,999
2,000 - 2,499
2,500 - 2,999
3,000 – 3,999
4,000 – 4,999
5,000 or more |
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5. About how much of your lighting is compact fluorescent (CFL) bulbs? |
None
1%-25%
26%-50%
Over 50% |
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6. Is your attic insulated? |
Yes
No |
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7. Do you experience any of these problems in your home? (check all that apply) |
Cold drafts in winter
Water condensation on windows in winter
Uneven temperatures from room to room
Heating system won’t keep home warm enough
Air conditioning system won’t keep home cool enough
I do not experience any of these |
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8. Number of occupants |
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9. Own or rent your home: |
Own
Rent |
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Appliances |
10. Refrigerators you use: |
None
1
2
3+ |
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11. Freezers you use: |
None
1
2
3+ |
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12. LCD or plasma TV’s you use: |
None
1
2
3+ |
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13. Ceiling fans you use: |
None
1
2
3+ |
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14. Desktop or laptop computers you use: |
None
1
2
3+ |
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15. Swimming pool pump: |
None (skip to #17)
1
2
3+ |
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16. Hours per day pool pump runs: |
Less than 5 hours
6-10 hours
11-15 hours
16-20 hours
More than 20 hours |
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17. Pool or hot tub heater: |
None
1
2
3+ |
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Heating, Cooling and Ventilation |
18. Primary heating fuel: |
Electric
Propane
Natural Gas
Wood
Fuel Oil
Other |
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19. Type of primary heating system: |
Geothermal heat pump
Air source heat pump
Dual-fuel heat pump
Electric furnace
Natural gas furnace
Propane furnace
Wood stove or fireplace
Electric thermal storage
Zoned electric (ceiling, cove, baseboard, wall unit)
Other
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20. Do you use portable electric plug-in heaters in your home? |
Yes
No |
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21. Approximate year primary heating system was installed: |
Before 1986
1986 – 1990
1991 - 1995
1996 – 2000
2001 – 2005
After 2005 |
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22. Type of air conditioning: |
Geothermal heat pump
Air source heat pump
Dual-fuel heat pump
Central air
Window unit(s)
None (skip to #23) |
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23. Approximate year air conditioning system was installed: |
Before 1986
1986 – 1990
1991 - 1995
1996 – 2000
2001 – 2005
After 2005 |
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24. Air flow around and condition of outdoor A/C condenser or heat pump: |
Poor
1
2
3
4
5 Excellent |
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25. Programmable thermostat installed? |
Yes
No |
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26. Thermostat setting ( degrees F ). |
Winter
Summer
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27. How often do you change or clean your heating and air conditioning ductwork filter? |
Once a year
Twice a year
Quarterly
Every other month
Monthly |
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Water Heating |
28. Water heaters in use: |
1
2
3+ |
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29. Primary water heater fuel: |
Electric
Propane
Natural gas
Other
|
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30. Approximate year primary water heater was installed: |
Before 1991
1991-1995
1996-2000
2001-2005
After 2005 |
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31. Primary water heater size: (in gallons) |
20 – 29
30 – 39
40 – 49
50 – 59
60 – 69
70 – 79
80+
Tankless |
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32. Primary water heater thermostat setting: |
degrees F |
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33. Hot water pipe wrap insulation: |
Yes
No |
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34. Reduced-flow showerheads or sink aerators: |
Yes
No |
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Weatherization |
35. Wall penetrations properly sealed to prevent drafts and air leakage (outlets, light fixtures, pipes, phone, cable): |
Poor
1
2
3
4
5 Excellent |
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36. Caulking or weatherstripping seal around doors and windows frames: |
Poor
1
2
3
4
5 Excellent |
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37. Type of fireplace(s): |
Wood-burning
Natural gas or propane
None (skip to #39) |
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38. Fireplace has doors |
Yes
No |
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39. Fireplace damper(s) closed when not in use: |
Yes
No |
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40. Condition of skirting and ductwork underneath manufactured or mobile home: |
Poor
1
2
3
4
5 Excellent
Not mobile/manufactured home |
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41. Type of windows: |
Single-pane
Double-pane
Storm windows
Low-E windows |
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