Form 5900-382 ENERGY STAR Certfication Audit Form

OMB Control No. 2060-0347

Expiration Date: XX/XX/XXXX

Approved while under OMB review

ENERGY STAR® Certification Audit: 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 in the same email as 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. 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/XXXX 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.
	EPA Form No. 5900-382 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, as-built 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: Click here to enter text. Application Tracking Number:
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. Click here to enter text.
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: Click here to enter text.

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.

If a representative of the Licensed Professional visited the property, please provide a detailed summary of the instructions given by the Licensed Professional to the person(s) performing the site visit and verifying the application contents: Click here to enter text.

[Optional] How much time was spent at the property during the site visit?

☐ Less than 2 hours

☐ 2-4 hours

☐ 4-8 hours

☐ More than 8 hours

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:

Click here to enter text.

Indoor Environmental Quality

Please provide a completed copy 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 in the same email as this audit form.

Please ensure that the form has been signed by the Licensed Professional. Refer to the Guide for Licensed Professionals for more information on how the required indoor environmental standards should be verified at www.energystar.gov/lpguide.

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)
Click here to enter text.	Click here to enter text.	Yes/No
Click here to enter text.	Click here to enter text.	Yes/No
Click here to enter text.	Click here to enter text.	Yes/No
Click here to enter text.	Click here to enter text.	Yes/No
Click here to enter text.	Click here to enter text.	Yes/No
Click here to enter text.	Click here to enter text.	Yes/No
IT Meter Name	Location	12 months of Meter Readings (Yes/No)
Click here to enter text.	Click here to enter text.	Yes/No
Click here to enter text.	Click here to enter text.	Yes/No

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.

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0347). Responses to this collection of information are voluntary (Section 103(g) Clean Air Act). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to average 45 minutes to 1 hour and 45 minutes 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 to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 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.