Can this form be signed electronically?

Yes. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. ch. 96, 2000) and UETA where adopted, provided the signature demonstrates intent, consent, attribution, and retention capability.

Who is authorized to sign the assessment?

Authorized signers are typically the facility owner, facility manager, or a delegated representative. Programs may require proof of authority such as a board resolution, lease, or written delegation.

Is notarization ever required?

Some funding programs or local rules require notarized attestation. Check program guidance; if notarization is required, remote online notarization may be accepted where state law allows.

How do I correct errors after submission?

Submit a revised assessment with a clear change log and signer attestation. Programs often require resubmission with a new signature and date to accept corrections.

What if meter history is incomplete?

Document available data, note gaps, and include a plan to obtain missing utility records. Lack of historic data can affect baseline calculations and program eligibility.

How long should I keep completed forms?

Retain signed assessments and supporting records per program rules; generally retain for at least the project term plus three years and follow federal or HIPAA retention where applicable.

Electronic Signature
Templates
Miscellaneous
Energy Efficiency Assessment Form

Energy Efficiency Assessment Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

ENERGY EFFICIENCY ASSESSMENT AGREEMENT

This Energy Efficiency Assessment Agreement (the Agreement) is made between:

Assessor Name: Client Name:

WHEREAS

WHEREAS, the Assessor is qualified and experienced to perform energy efficiency assessments, audits, and related advisory services; and

WHEREAS, the Client desires to obtain an assessment of energy consumption, efficiency opportunities, and estimated savings for the property identified in this Agreement and agrees to engage the Assessor on the terms set forth herein.

WHEREAS, the parties intend for the assessment work and any deliverables to be governed by the terms of this Agreement.

PROJECT & SITE INFORMATION

Project Address:

Assessment Date: Primary Contact: Contact Phone:

SCOPE OF WORK

The Assessor shall perform a comprehensive energy efficiency assessment at the Project Address. The assessment will include site inspection, utility data review, equipment inventory, on-site measurements, identification of energy conservation measures (ECMs), and preparation of a written report containing findings, recommended measures, and estimated energy and cost savings. The Assessor will not perform construction, installation, or commissioning unless separately contracted.

Detailed Scope (describe specific tasks and limitations):

SITE SURVEY & EQUIPMENT INVENTORY

Major Equipment Observed (make/model, quantity):

Utility Billing Data Provided: Yes Metered Interval Data Available: Yes

ASSESSMENT FINDINGS

Energy Baseline (period, usage, peak demand): Measurements & Readings (temperatures, flow rates, voltages, etc.): Recommended Energy Conservation Measures (ECMs):

Estimated Annual Energy Savings (kWh): Estimated Annual Cost Savings ($):

PAYMENT TERMS

Assessment Fee: The Client shall pay the Assessor a fixed fee for the services described in this Agreement.

Total Assessment Fee ($): Payment Schedule:

Late Payment Fee: Payments to be made to:

TERM AND TERMINATION

This Agreement shall commence on the Start Date and shall continue until completion of the services or until the End Date, unless earlier terminated in accordance with this section.

Start Date: End Date:

Termination Notice Period (days):

Either party may terminate this Agreement for material breach if the other party fails to cure such breach within the notice period specified above. Termination shall not relieve the Client of the obligation to pay for services performed through the effective date of termination.

CONFIDENTIALITY

The Assessor and the Client each acknowledge that, in the course of performance, they may receive Confidential Information from the other. "Confidential Information" means non-public business, technical, or financial information disclosed in connection with this Agreement. Each party shall (i) hold Confidential Information in confidence, (ii) use it only for the purpose of performing obligations under this Agreement, and (iii) not disclose it to third parties without prior written consent, except as required by law. Confidentiality obligations shall survive termination for a period of three (3) years.

LIMITATION OF LIABILITY

Except for liability arising from gross negligence or willful misconduct, each party's aggregate liability under this Agreement shall not exceed the total fees paid by the Client to the Assessor for the services rendered under this Agreement. The Assessor does not guarantee specific energy savings; all estimates are projections based on available data and professional judgment.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the state specified below. The parties submit to the exclusive jurisdiction of the courts located in that state for disputes arising out of or relating to this Agreement.

Governing State:

ENTIRE AGREEMENT

This Agreement, including any exhibits and attachments incorporated herein, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior and contemporaneous negotiations, proposals, and agreements, whether written or oral. Any amendment or modification to this Agreement must be in writing and signed by both parties.

CERTIFICATION & ATTACHMENTS

The Assessor certifies that personnel performing the assessment are appropriately qualified and that findings and recommendations will be prepared in accordance with generally accepted industry practices. The Client represents that it has authority to authorize the assessment and to provide access to the property.

Attachments Included (check all that apply):

Utility Billing History Site Photographs One-line Diagrams

NOTICES

Notices required under this Agreement shall be in writing and delivered to the address of the party provided below or to such other address as either party designates in writing.

Assessor Address for Notices: Client Address for Notices:

Assessor:

By:

Date:

Client:

By:

Date:

What the Energy Efficiency Assessment Form Is

The Energy Efficiency Assessment Form is a structured report used to document building energy use, equipment inventory, inspection findings, and recommended measures to reduce energy consumption. It captures baseline meter readings, operational patterns, and physical attributes that affect performance, producing a standardized record for owners, facility managers, auditors, utilities, and incentive programs. The form supports consistent comparisons across properties, enables eligibility checks for rebate or grant programs, and creates an auditable record that can be retained electronically under applicable recordkeeping rules.

Why this Form Matters for Projects and Programs

A completed Energy Efficiency Assessment Form documents baseline conditions, supports funding eligibility, and clarifies priority measures for cost-effective upgrades. It reduces ambiguity in scope, makes technical recommendations auditable, and creates a consistent dataset for tracking savings over time.

Who typically completes and relies on this form

Typical users include auditors, facility managers, owners, and program administrators who need a verified record of building energy characteristics.

Energy auditors and consultants conducting site surveys, documenting meter reads, and producing upgrade recommendations for clients or programs.
Facility managers and building owners tracking baseline consumption, scheduling improvements, and verifying post-installation performance.
Utility program administrators and grant managers using standardized assessments to screen projects and validate incentive eligibility.

Use this form to coordinate stakeholders and create a defensible, traceable basis for retrofit decisions and incentive claims.

Core sections to include in a professional assessment

A professional Energy Efficiency Assessment Form combines site data, measured consumption, an equipment inventory, inspection notes, measured or estimated savings, and a cost estimate for prioritized actions.

Property ID

Unique property identifier, address, facility type, and occupancy that allow consistent cross-referencing across program records and follow-ups.

Baseline Energy Use

Recent utility meter readings, billing period, and normalized kWh/therm or kBtu/sq ft values to establish a performance baseline.

Equipment Inventory

Make, model, nameplate data, and age of HVAC, lighting, motors, and controls to identify retrofit candidates and efficiency ratings.

Inspection Checklist

Room-by-room or system-specific checklist documenting condition, controls, insulation, air sealing, and observable maintenance issues.

Savings Recommendations

Ranked measures with estimated energy savings, simple payback, and confidence level to support decision-making and incentive calculations.

Cost & Timeline

Preliminary installed cost ranges, estimated implementation timeline, and notes on required permits or contractor scope.

Step-by-step: completing the assessment form

Follow these sequential steps to prepare, document, and finalize a compliant assessment.

01

Prepare documents: Gather utility bills, equipment manuals, and lease or ownership proof.
02

Conduct inspection: Walk the site, note system conditions, and take photographs.
03

Record measurements: Log meter readings, operating hours, and rated equipment data.
04

Finalize report: Compile findings, calculate savings, and sign off on recommendations.

Configuring an online workflow for the form

Set up digital fields, signer roles, and routing rules before sending the form for signatures and submission.

Field \| Configuration	Type \| Required \| Conditional
Authentication	Email link with optional SMS code for higher assurance
Template	Save a reusable template with locked sections for auditors
Conditional Fields	Reveal cost estimate fields when a retrofit is proposed
Export Format	PDF/A for archive and CSV for data export

Where the completed form goes and how it moves

Document the routing path so every stakeholder receives the correct version and an auditable trail is preserved.

Upload form: Send completed assessment to program portal or document repository.
Assign signers: Add authorized signers and set signing order if required.
Sign & certify: Signatures and timestamps create the official record of the assessment.
Share copies: Distribute final report to owner, utility, and program administrator.

Technical and platform considerations for eSubmission

Confirm supported file formats, integrations, and security standards before using an electronic workflow for assessments.

File formats: PDF, DOCX, XLSX supported
Integrations: Salesforce, NetSuite, Google Workspace integrations
Security standards: AES-256 at rest; TLS 1.2/1.3

Typical deadlines and processing expectations

Timeframes vary by program; confirm specific submission windows and implementation deadlines with the administering organization.

Assessment completion:

Commonly required within 30 days of site visit

Report submission:

Submit final report within 60 days to qualify for most rebates

Reassessment cycle:

Annual or on significant equipment changes

Implementation timeline:

Upgrades often expected within 6–12 months

Grant program dates:

Deadlines and funding windows vary by program

Common mistakes that delay approval or payment

Incomplete meter history or mismatched billing periods that prevent accurate baseline calculations and trigger requests for additional documentation.
Using inconsistent facility names or addresses that do not match utility account records, causing verification failures and processing delays.
Omitting required signatures, dates, or signer authority statements, which can render an assessment noncompliant for incentive disbursement.
Poorly documented equipment details (missing model or nameplate data) that increase uncertainty and reduce accepted energy savings estimates.

Risks and consequences of incorrect or incomplete forms

Funding denial: Missing or inconsistent data can disqualify a project from rebates or grants.

Clawback risk: If errors are found during audit, funds may need to be repaid.

Safety citation: Incorrect equipment information can conceal safety issues leading to violations.

Audit findings: Inadequate documentation increases exposure during program audits.

Delay penalties: Missed implementation deadlines may forfeit incentive tiers.

Contract breach: Noncompliance with contractual reporting obligations may trigger remedies.

Security, privacy, and compliance checkpoints

Encryption: AES-256 at rest; TLS 1.2/1.3 in transit

Audit Trail: Timestamps, IP, and action history for each signer

HIPAA Support: HIPAA-compliant workflows available with BAA

Regulatory Fit: 21 CFR Part 11 support for regulated workflows

Certifications: SOC 2 Type II and ISO 27001 certified

Accessibility: WCAG 2.0 Level AA accessibility compliance

Frequently asked questions about using this form

Answers to common questions cover eSignature validity, signer authority, notarization, revisions, and handling missing data.

Need help? Contact support

Can this form be signed electronically?
Yes. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. ch. 96, 2000) and UETA where adopted, provided the signature demonstrates intent, consent, attribution, and retention capability.
Who is authorized to sign the assessment?
Authorized signers are typically the facility owner, facility manager, or a delegated representative. Programs may require proof of authority such as a board resolution, lease, or written delegation.
Is notarization ever required?
Some funding programs or local rules require notarized attestation. Check program guidance; if notarization is required, remote online notarization may be accepted where state law allows.
How do I correct errors after submission?
Submit a revised assessment with a clear change log and signer attestation. Programs often require resubmission with a new signature and date to accept corrections.
What if meter history is incomplete?
Document available data, note gaps, and include a plan to obtain missing utility records. Lack of historic data can affect baseline calculations and program eligibility.
How long should I keep completed forms?
Retain signed assessments and supporting records per program rules; generally retain for at least the project term plus three years and follow federal or HIPAA retention where applicable.

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