Energy Conservation Services, Inc.
188 Broadway, P.O Box 116, Port Ewen, NY 12466
info@ecshv.com
(845) 338-3864
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Insulation & Air Sealing
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Comfort & Energy Assessment Tool
This form is to be completed by Energy Conservation Services staff.
Today's Date
First Name
Last Name
Address
Phone
Email
Date of Occupancy
Year Built
Architectural Style
Choose an option
Bugalow
Cape Cod
Colonial
Contemporary
Cottage
Empire
Farmhouse
Federalist
Four Square
Georgian
Gothic Revival
Greek Revival
Italianate
Mid-Century Modern
Modular
Ranch
Raised Ranch
Saltbox
Tudor
Victorian
Vernacular
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# Stories
Choose an option
1
2
3
4 or more
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# Occupants
Choose an option
1
2
3
4
5
6
7
8
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# Bedrooms
Choose an option
1
2
3
4
5
6
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# Baths
Choose an option
1
1 1/2
2
2 1/2
3
3 1/2
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Conditioned Square Footage
Average Ceiling Height
Exterior Siding
Choose an option
Aluminum
Asbestos shingle
Board & Batten
Brick
Clapboard
Shake
Stone
Vinyl
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Level of shielding
Choose an option
None
Light (few obstructions)
Moderate (obstruction within 30 ft)
Typical suburban (Bldg/Trees within 30 ft)
Typical downtown
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Foundation type
Choose an option
Slab-on-grade
Slab below grade
Dirt
Stone
Brick
Concrete Block
Poured Concrete
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Basement or Crawlspace
Choose an option
Basement
Crawlspace, Vented
Crawlspace, Unvented
Partial Basement & Partial Crawlspace
None
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Attic Venting
Ridge vent
Gable vents
Soffit vents
Roof vent
Fan
None
Attic or Cathedral
Flat attic (adequate clearance)
Flat attic (inadequate clearance)
Cathedral ceiling
Some flat attic & some cathedral
Knee Wall Attic/s (accessible)
Knee wall attic (inaccessible)
Attic Access
Hatch
Door
Pulldown stairs
None
End Wall Insulation?
Yes
No
Plumbing vents to roof?
Yes
No
Air Sealing?
Yes
No
Some but Incomplete
Duct Work Type?
Choose an option
Galvanized Steel
Flex Duct
Other
None
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Wall Framing
2 x 4
2 x 6
2 x 8
2 x 10
2 x 12
Exising Wall Insulation
Choose an option
None
Fiberglass
Cellulose
Closed Cell Foam (at least 3")
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Attic Framing (Ceiling Joists)
Choose an option
2 x 4
2 x 6
2 x 8
2 x 10
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Existing Attic Insulation
Fiberglass
Vermiculite
Cellulose
Rockwool
Denim
Open cell spray foam
Closed cell spray foam
Wool
Rigid foam board - polystyrene or polyurethane
Rigid foam board - polyisocyanurate
Rafters
Choose an option
2 x 4
2 x 6
2 x 8
2 x 10
2 x 12
2 x 4 w/trusses
2 x 6 w/trusses
2 x 8 w/trusses
2 x 10 w/trusses
2 x 12 w/trusses
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Spacing
16" on center
24" on center
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