5900-382 Spot Audit Form

OMB Control No. 2060-0347

ENERGY STAR® Certification Spot Audit: Instructions
	EPA is performing audits on applications for ENERGY STAR certification to ensure that all reported values submitted during the application process have been accurately entered in Portfolio Manager®. Your application has been randomly selected for an audit and will be processed alongside the information you provide in this audit document. The status of your application is contingent on the approval of all entries in your application and audit. As part of the audit process, EPA is requesting that you provide detailed explanations and/or documentation for each of the following application sections: - Property Information - provide a description of your property along with details from your site visit - Indoor Environmental Standards - provide a detailed description of the approaches used to verify indoor environmental standards. Refer to the Guide for Licensed Professionals for More Information. http://www.energystar.gov/buildings/tools-and-resources/energy-star-guide-licensed-professionals - Total Building Energy Use - explain what fuel types are being used at the property and provide the 12 months of utility bills that were included in the application for each meter. - Property Use Details - provide an explanation of how values were determined for all property use details, along with supporting documentation as appropriate and available. When reviewing this audit documentation, EPA is looking for both an explanation of how all values were confirmed during the site visit as well as proof that the applicant and LP understand Portfolio Manager definitions and policies.
	Please complete this audit document by XX/XX/201X in order to avoid delays in the processing of this application. If you have any questions while completing the form, please send them to escertification@icfi.com
	Attachments: Please list the supporting documents that you have included as part of this audit in the space below. 12 months of utility bills for each meter used at the property are required. Optional attachments may include photographs, building drawings or any other materials that will help EPA verify the values submitted as part of the application. Click here to enter text.

Property Information
Property Name: Click here to enter text. Street Address: Click here to enter text.	Portfolio Manager Property ID: Click here to enter text. Primary Property Type: Click here to enter text.
City, State, Zip: Application Tracking Number: Click here to enter text.
Property Description
Please describe the main uses and occupants/tenants at the property, major energy using systems, property features, and any other pertinent information. Please also confirm that the Primary Property Type listed above matches EPA’s definition for that property type. For example, in order for a property to be correctly classified as Retail, its Gross Floor Area must be greater than 5,000 sq. ft. and it must have at least one exterior entrance to the public.
Link to property website (if available): Click here to enter text. Link to property image on a satellite map (if available): Click here to enter text. Does this application represent the entire property? If any spaces or structures have been excluded, please explain here:

Site Visit

Date(s) of the site visit: Click here to enter text.

Who conducted the site visit (name, organization, title): Click here to enter text.

Did any edits need to be made to the application following the site visit (Yes/No)? Click here to enter text.

If yes, please explain the edits that were made:

Indoor Environmental Standards
	Ventilation for Acceptable Indoor Air Quality Please explain how you verified that this property meets the most recent ASHRAE Standard 62 for ventilation for acceptable indoor air quality: Click here to enter text.
Acceptable Thermal Environmental Conditions Please explain how you verified that this property meets acceptable thermal environmental conditions as established by ANSI/ASHRAE Standard 55 “Thermal Environmental Conditions for Human Occupancy”: Click here to enter text.
While conducting the site visit, did you observe any indications of thermal discomfort such as personal fans, space heaters, or altered thermostats? If yes, please explain below. Click here to enter text.
	Adequate Illumination Please explain how you verified that this property meets acceptable illumination levels in accordance to the luminance determination procedure of the Illuminating Engineering Society of North America (IESNA) Lighting Handbook. Click here to enter text.

Energy Consumption Data
Please submit copies of twelve months of the utility bills reported in your ENERGY STAR application. You may use the checklist below to confirm that all meters have been included in the audit documentation.
Meter Name	Fuel Type	12 months of Bills Provided (Yes/No)
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IT Meter Name	Location	12 months of Meter Readings (Yes/No)
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How was it verified that all meters have been included in the application? Click here to enter text.
If this application was for a property with multiple tenants and you do not have access to utility bills, please explain how the total energy usage of the property was determined and provide master meter readings or a calculated aggregate of all tenant meters. Click here to enter text.

Office: Office 1
	Gross Floor Area	Reported Value: Click here to enter text.
	How was this value verified? If the reported value changed during the 12-month application period, please explain why the value changed and how the previous value was verified.
	Weekly Operating Hours	Reported Value: Click here to enter text.
	How was this value verified? If the reported value changed during the 12-month application period, please explain why the value changed and how the previous value was verified. Click here to enter text.
	Number of Computers	Reported Value: Click here to enter text.
	How was this value verified? If the reported value changed during the 12-month application period, please explain why the value changed and how the previous value was verified. Click here to enter text.

Office: Office 1
	Number of Workers on Main Shift	Reported Value: Click here to enter text.
	How was this value verified? If the reported value changed during the 12-month application period, please explain why the value changed and how the previous value was verified. Click here to enter text.
	Percent That Can Be Heated	Reported Value: Click here to enter text.
	How was this value verified? If the reported value changed during the 12-month application period, please explain why the value changed and how the previous value was verified.
	Percent That Can Be Cooled	Reported Value: Click here to enter text.
	How was this value verified? If the reported value changed during the 12-month application period, please explain why the value changed and how the previous value was verified. Click here to enter text.

Data Center: Third Floor Data Center
	Gross Floor Area	Reported Value: Click here to enter text.
	How was this value verified? If the reported value changed during the 12-month application period, please explain why the value changed and how the previous value was verified.
	IT Energy Configuration	Reported Value: Click here to enter text.
	How was this value verified? If the reported value changed during the 12-month application period, please explain why the value changed and how the previous value was verified.
	IT Energy Meter Location
	Where in the Data Center is the IT meter located? How was this verified? Click here to enter text.

Data Center: Third Floor Data Center
	IT Energy Included in Total Building Energy
	Is the IT energy meter also included in the total building energy? How was this verified?

The public reporting and recordkeeping burden for this collection of information is estimated to average 1 to 2 hours per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

0 EPA Form No. 5900-382

Spot Audit form for Application Tracking Number XXXXXX-X-XXXXXXXX