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Energy Assessment Form

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ENERGY ASSESSMENT FORM

This Energy Assessment Form (the "Agreement") is executed as of by and between:

WHEREAS

WHEREAS, Assessor is duly qualified and experienced to perform an energy assessment of buildings, systems and equipment and to provide written findings and recommendations; and

WHEREAS, Client desires to obtain a professional assessment of the Property's energy use, equipment efficiency and opportunities for energy cost reduction, and agrees to the Scope of Work and Payment Terms set forth herein; and

WHEREAS, the parties wish to define the responsibilities, deliverables, limitations and legal terms governing the assessment.

PROPERTY & ASSESSMENT INFORMATION

Inspection Date:

Building Type:

Square Footage:

Walk-through energy survey    ASHRAE Level II (detailed)    ASHRAE Level III (investment-grade)

SCOPE OF WORK

Assessor will perform an on-site assessment of the Property and will provide a written report containing:

ASSESSMENT DETAILS

RECOMMENDATIONS & ESTIMATED BENEFITS

Estimated Annual Savings:

Estimated Implementation Cost:

Estimated Payback Period:

PAYMENT TERMS

Client agrees to pay Assessor the total fee as set forth below. Payment shall be made in accordance with the agreed schedule. A non-refundable deposit is due prior to commencement of site work.

Late Fee: . Client agrees that unpaid balances shall incur the stated late fee until paid in full.

TERM AND TERMINATION

This Agreement commences on Start Date: and continues until completion or End Date: , unless earlier terminated in accordance with this section.

Either party may terminate this Agreement for convenience by providing written notice at least days prior to termination. Upon termination, Client shall pay Assessor for services performed and reasonable costs incurred up to the termination date.

CONFIDENTIALITY

Both parties agree to keep all non-public information obtained under this Agreement confidential and to use such information solely for the purposes of performing or receiving the assessment. Confidential information does not include information that (i) is or becomes public other than by breach of this Agreement, (ii) is rightfully received from a third party without restriction, or (iii) is required to be disclosed by law or regulation, provided the disclosing party gives prompt written notice to the other party.

LIMITATIONS & WARRANTY

Assessor will exercise professional skill and care in conducting the assessment. Results, cost estimates and savings projections are estimates only and do not constitute a guarantee of energy savings or financial return. Client acknowledges that Assessor's obligations are limited to the scope of work described herein. Except as expressly stated, there are no warranties, express or implied, including merchantability or fitness for a particular purpose.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the state specified by the Client at the time of signature. Any dispute arising under this Agreement shall be resolved in the courts having jurisdiction in that state.

ENTIRE AGREEMENT

This Agreement, including attachments and referenced schedules, constitutes the entire agreement between the parties regarding the subject matter and supersedes all prior and contemporaneous agreements, representations and understandings, whether written or oral.

ACCEPTANCE AND CERTIFICATION

By signing below, Client accepts the Scope of Work, Payment Terms and other provisions of this Agreement and authorizes Assessor to perform the assessment. Client certifies that, to the best of their knowledge, the information provided in this form is true and accurate.

Certification: I certify that I am authorized to execute this Agreement on behalf of the Client named above.

Assessor Printed Name:

By (Signature):

Date:

Client Printed Name:

By (Signature):

Date:

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What the Energy Assessment Form Is and when it matters

An Energy Assessment Form documents a building or facility's energy use, equipment inventory, and recommended efficiency measures. It records measurable data—meter readings, HVAC details, insulation, lighting types—and summarizes findings such as projected energy savings and payback estimates. Organizations use the form to qualify for incentives, meet program or permitting requirements, or support upgrades and financing. The form typically accompanies proposals, grant applications, utility rebate requests, or compliance filings and serves as the official record of the survey and recommended actions.

Why a standardized Energy Assessment Form matters

A consistent form ensures data accuracy, supports eligibility for rebates or financing, and creates an auditable record for compliance or performance tracking. Standardized fields reduce disputes and speed review by utilities, contractors, and program administrators.

Why a standardized Energy Assessment Form matters

Who completes and uses an Energy Assessment Form

The form is completed by qualified assessors and used by property owners, facility managers, utilities, and program administrators to validate energy-saving measures.

  • Licensed energy auditors, contractors, or certified assessors performing the on-site survey and entering measured data and observations.
  • Property owners or facility managers who provide access, utility bills, and approve recommendations for retrofits or upgrades.
  • Utility program staff, rebate administrators, or lenders who review the assessment to determine eligibility and approve incentives or financing.

Accurate completion reduces processing delays and makes the assessment actionable for retrofit planning, incentive approval, and performance tracking.

Essential sections to include in a professional Energy Assessment Form

A comprehensive form groups site identification, measured baseline data, recommended measures, cost estimates, and certification statements to create a single authoritative record for reviewers.

Site Details

Property name, address, building type, square footage, and primary use; enables consistent identification across applications and audits and ties the assessment to utility accounts.

Baseline Data

Measured meter readings, recent utility bills, occupancy patterns, and baseline HVAC and lighting specifications to establish current energy consumption and identify anomalies.

Equipment Inventory

Detailed list of HVAC units, boilers, chillers, lighting fixtures, controls, and insulation levels with make/model and age to support measure selection and sizing.

Recommended Measures

Specific retrofit actions, performance assumptions, estimated energy savings, lifespan, and implementation sequence so reviewers can evaluate cost-effectiveness.

Cost & Savings

Line-item cost estimates, incentive assumptions, simple payback and net present value figures to support funding decisions and rebate eligibility.

Certifications

Assessor signature, credentials, inspection date, and statements of accuracy or compliance to meet program or permitting evidence requirements.

Required data fields at a glance

Assessor Name: Full legal name
Assessor Credentials: License or certification
Site Address: Street, city, state, ZIP
Inspection Date: MM/DD/YYYY
Utility Account: Account or meter ID
Signature: Signed and dated

Step-by-step: completing the Energy Assessment Form

Follow a structured sequence to collect, verify, and record site observations and calculations to produce a reliable, review-ready assessment.

  • 01
    Prepare: Gather utility bills and equipment records before the site visit.
  • 02
    Inspect: Measure equipment, document conditions, and take photos for reference.
  • 03
    Record: Enter meter readings, equipment specs, and occupancy data into the form.
  • 04
    Calculate: Estimate savings, costs, and payback using documented assumptions.

Configuring an online Energy Assessment workflow

Design the digital workflow to collect data, route reviews, and capture signatures with clear field mapping and authentication settings.

Field Configuration
Site ID field Required, single-line text
Meter upload PDF or image attachment allowed
Assessor signature eSignature field with date
Reviewer routing Sequential approval workflow

Where to send the completed Energy Assessment Form

Route the final form to all stakeholders and maintain an archived copy for compliance and future reference.

  • Owner: Deliver signed copy to property owner for records.
  • Utility Program: Submit to rebate administrator or program portal as required.
  • Contractor: Share recommendations and cost estimates with the implementation contractor.
  • Archive: Retain a certified copy in document management for audits.

Digital submission and signature considerations

Ensure the platform supports required file formats, attachments, and secure signer authentication before collecting signatures.

  • File formats: PDF, DOCX supported
  • Authentication: Email or SMS code
  • Audit trail: Timestamp and IP logged

Typical timelines and processing expectations

Set realistic timelines for inspection, reviewer feedback, and incentive approvals to avoid project scheduling conflicts.

On-site inspection window:

Schedule within 7–14 days of request

Form submission:

Submit signed form within 30 days of inspection

Reviewer response:

Expect program review in 10–30 business days

Incentive approval:

Approval varies; allow 30–90 days

Implementation window:

Complete upgrades within program-specified period

Common preparation errors to avoid

  • Incomplete equipment details that prevent verification of rated performance and disqualify measures.
  • Using inconsistent or missing utility account identifiers, which delays validation of baseline consumption.
  • Entering dates in mixed formats that cause automated workflows to reject the submission.
  • Failing to attach required supporting documents, such as recent utility bills or equipment photos.

Risks and consequences of incorrect or incomplete forms

Incentive denial: Missing or incorrect data can result in rebate or incentive rejection.
Warranty voidance: Improper documentation may affect manufacturer or performance warranties.
Project delays: Requests for missing information extend approval and construction timelines.
Financial exposure: Incorrect savings estimates can lead to repayment or audit adjustments.
Regulatory noncompliance: Failure to meet local program rules risks penalties or corrective action.
Data privacy: Unauthorized disclosure of customer data can trigger legal issues.

Representative use cases for an Energy Assessment Form

These examples show how organizations use the form to qualify projects, document savings, and secure funding.

Small Office Renovation

A 10,000 ft² office requested a baseline audit to qualify for a utility rebate.

  • The assessor documented lighting and HVAC inefficiencies.
  • The report supported a $12,500 rebate and provided a two-year simple payback estimate used to secure low-interest financing for LED and control upgrades.

Municipal Building Upgrade

A city commissioned assessments for three municipal buildings to prioritize upgrades.

  • Assessments included equipment inventories and occupancy schedules.
  • The consolidated findings enabled phased retrofits funded by a mix of municipal bonds and state energy grants, reducing annual energy costs across the portfolio.

eSignature vendor comparison for submitting Energy Assessment Forms

Compare core plan pricing and key features relevant to form submission, large-volume workflows, and compliance needs; signNow appears first for parity.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial No No Yes, limited Yes, limited
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

FAQs and troubleshooting for the Energy Assessment Form

Answers to common questions about completion, e-signing, submission, and retention for energy assessments.


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