5900-382 ENERGY STAR Certification Audit Form

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Instructions
To help ensure the integrity of the ENERGY STAR® brand, EPA is performing audits on certification
applications to ensure that all energy use is accounted for accurately, the building characteristics have
been properly reported, and indoor environmental quality has not been compromised in pursuit of
energy conservation. 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 Quality - provide a completed version of the Indoor Environmental
Quality Measurement Form. You may have already completed this form as part of your site visit.
If not, a copy has been included at the end of this audit form. Refer to the Guide for Licensed
Professionals for more information:
www.energystar.gov/lpguide.

•

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. Demonstrate that
the applicant and LP understand Portfolio Manager definitions and policies.

Please complete this audit document by [MM/DD/YYYY] 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@energystar.gov.
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.

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Property Name:

Property ID:

Street Address:
City, State, ZIP:

Primary Property Type:

Application Tracking Number:

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Date(s) of the site visit:
Who conducted the site visit (name, organization, title):

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