Jason Plein
CMA, CMR
4314 S 97th Ave
Tolleson, AZ 85353
(623) 521-1833
Active NORMI Member

Summary of Energy Assessment

Thank you for taking the time to complete this summary of the Energy Assessment Booklet you received with your PSP Kit. This summary takes the most relevant parts of your assessment and develops a report of recommendations from which your Professional Screening Partner may assist you with solutions. Please make sure each question is answered.

Name
Address
City
State/Province
Zip/Postal Code
Phone
eMail

Page 8 of the Energy Assessment Booklet - Perimeter Walls
	Please enter your answer to question 7	Yes No
	Please enter your answer to question 8	Yes No

Page 9 of the Energy Assessment Booklet - Floors
	Please enter your answer to question 9	Yes No
	Please enter your answer to question 10	Yes No
	Please enter your answer to question 11	Yes No
	Please enter your answer to question 12	Yes No

Page 9 of the Energy Assessment Booklet - Ceilings
	Please enter your answer to question 1	Yes No
	Please enter your answer to question 2	Yes No
	Please enter your answer to question 3	Yes No

Page 10 of the Energy Assessment Booklet - Heating & Cooling
	Please enter your answer to question 1	Yes No
	Please enter your answer to question 3	Yes No
	Please enter your answer to question 4	Yes No

Page 11 of the Energy Assessment Booklet - Heating & Cooling
	Please enter your answer to question 5	Yes No
	Please enter your answer to question 6	Yes No
	Please enter your answer to question 7	Yes No
	Please enter your answer to question 8	Yes No
	Please enter your answer to question 9	Yes No
	Please enter your answer to question 10	Yes No
	Please enter your answer to question 11	Yes No


Page 12-15 of the Energy Assessment Booklet - Electrical Appliances
	Do any of the appliances you listed on pages 12-15 have LED Lights?	Yes No

Page 16-19 of the Energy Assessment Booklet - Electrical Lighting
	Page 16 Total Usage
	Page 17 Total Usage
	Page 18 Total Usage
	Page 19 Total Usage

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Summary of Energy Assessment