Personal Home Energy Audit Self-Assessment Form

Personal Home Energy Audit Self-Assessment Form — Form Fields

This personal template includes 12 fields. Conduct a personal home energy audit to identify inefficiencies and opportunities to reduce utility bills. Free to customize and use on ZenBuild.

• Your Name (text, required)
• Home Address (text, required)
• Average Monthly Electricity Bill ($) (number, required)
• Average Monthly Gas/Heating Bill ($) (number, required)
• Home Type (dropdown selection, required) — options: Single family house, Townhouse, Apartment, Condo, Mobile home
• Home Square Footage (number, optional)
• Insulation Quality (estimated) (dropdown selection, required) — options: Excellent, Good, Fair, Poor, Unknown
• Windows Type (dropdown selection, required) — options: Double-pane, Single-pane, Triple-pane, Unknown
• HVAC Age (dropdown selection, required) — options: Under 5 years, 5-10 years, 10-15 years, 15-20 years, 20+ years, Unknown
• Energy saving measures already in place (checkboxes, optional) — options: LED lighting throughout, Smart thermostat, Solar panels, Energy Star appliances, Programmable water heater, Weatherstripping on doors, Attic insulation
• Biggest energy waste you suspect (dropdown selection, required) — options: Heating/cooling loss, Older appliances, Hot water heating, Lighting, Electronics standby power, Unknown
• What improvements are you considering? (long text, optional)