Pre-Audit Screening Questionnaire

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What kind of heating system do you have?

Boiler - Radiators

Furnace -Ducting

Boiler - Baseboard

Do you use air conditioning?

Yes, window units

No

Yes, central air

Yes, some other AC method

Please mark any health and safety issues:

Mold

Water in basement

Pests

Damage to basement stairs

Structural Damage

Other Issue [describe in comments]

No H&S issues

Please describe any marked issues here

Comfort issues and home layout

Thanks for submitting! We'll follow up by phone or email for your next steps!

Energy Coordinating Agency

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