This document is a quality control checklist for evaluating weatherization work done on a home. It includes sections to check file documentation, conduct on-site visual inspections and diagnostic tests of infiltration, HVAC systems, attics, subspaces, windows/doors and other measures. Test results from before, after and the quality control inspection are recorded. The checklist also documents any needed call back items or additional training and allows for commenting on the overall quality of the work.

1. Quality Control Check list (Draft Template)
Agency Job #: ______________________________ Agency Name _______________________________
Client Name: ______________________________ _ Owner Renter Prior QCI Inspections (1) (2) (3) (n/a)
Address: _____________________________________________________________ QC Inspection Date: ________________________
Quality Control Inspector:_________________________________ QCI Contact & Phone: __________________________________
Agency Contact Name and phone/email ____________________________ ______________________________________________________
Housing Type: Single Family Mobile Home Multi-family Shelter Manufactured Housing
Primary Fuel: Natural Gas Propane Electric Oil Other: _____________
Secondary /Supplemental Fuel Source Natural Gas Propane Electric Oil Other: _____________
FILE REVIEW & QUALITY ASSURANCE
YES NO N/A
1. Eligibility Determination present?
2. Ownership Verification
3. Energy Audit Priority List
4. Work/Service Agreement
5. Work Order
6. Were OSHA safety standards followed?
7. Lead-Paint Notification Documented
8. Certified Renovator Documentation
9. Lead Safe Weatherization Documentation
Paperwork?
Photos?
10. Whole House Moisture Form Documentation
11. Wx Mold Assessment and Release Form
12. Asbestos Assessment/Release Form
13. Radon Information Form
14. Appropriate Signatures Verified
15. State Historic Preservation Documentation
16. Identification of Occupant Health Conditions
17. Call back Documentation
18. Are job anomalies sufficiently noted?
19. Energy Education provided? If so, when?
20. Final/Post Inspection Client Sign Off
21. Agency identified client complaint?
If so, resolved?
22. Client Interview by QCI, customer satisfied?
ON-SITE WORK ASSESSMENT / DIAGNOSTICS
VISUAL/SENSORY INSPECTION YES NO N/A Comments
1. Exterior Inspection of Home Performed
2. Interior Inspection of Home Performed
Comments

2. 3. Is there any damage potentially caused by workers?
USE DG-700 MANOMETER FOR ALL TESTING
INFILTRATION TESTING YES NO N/A
1. Pre & Post Blower Door Results (@CFM 50)
Pre #:_______________cfm Post #:_______________cfm QCI #: _________________cfm
Agency ASHRAE/BAS calculation results ______________________________________
QCI ASHRAE/BAS results _________________________________________________________
Intermediate Zonal Readings
1. Crawlspace/Basement (WRT House)
Pre #:_______________pa Post #:_______________pa QCI #: _________________pa
2. Attic (WRT House)
Pre #:_______________pa Post #:_______________pa QCI #: _________________pa
3. Garage (WRT House)
Pre #:_______________pa Post #:_______________pa QCI #: _________________pa
DIAGNOSTIC TESTING
1. Pressure Pan Test
Pre #:_______________pa Post #:_______________pa QCI #: _________________pa
2. Fan Flow Test
Pre #:_______________cfm Post #:_______________cfm QCI #: _________________cfm
3. Duct Pressurization Test (@CFM 25)
Pre #:_______________cfm Post #:_______________cfm QCI #: _________________cfm
HEATING, VENTILATION, AIR CONDITIONING YES NO N/A Comments – HVAC
1. Combustion Appliance Safety Tests
2. Heating System Replacement
3. Need for furnace replacement documented?
Manual J?
Photos?
4. Heating System Tune-Up/Filter
5. Distribution System Modifications
6. Duct Sealing
7. Set-Back Thermostat
8. Current ASHRAE calculations performed?
9. Ambient CO Testing
Outdoors:_______________ppm Indoors:_______________ppm CAZ: _________________ppm
Combustion Appliance Safety Test Results
1. DHW
Spillage:
Pre-work Pass/Fail/NA Post-work Pass/Fail/NA QCI: Pass/Fail/NA
CO:
Pre-work_________ppm Post-work_________ppm QCI: _________ppm
Efficiency:
Pre-work____________% Post-work____________% QCI:____________%
Gas Leak:
Pre-work Yes/No Post-work Yes/No QCI: Yes/No
Flue Pitch:
Comments – Infiltration

3. Pre-work Pass/Fail Post-work Pass/Fail QCI: Pass/Fail
WC CAZ:
Pre-work _______pa (Pass/Fail) Post-work_______pa (Pass/Fail) QCI: _______pa (Pass/Fail)
Draft:
Pre-work _________pa Post-work_________pa QCI:_________pa:
DHW (continued)
Temperature: (At TAP, in degrees)
Pre-work_________∘ Post-work_________∘ QCI:_________ ∘
2. Furnace/Boiler
Spillage:
Pre-work Pass/Fail/NA Post-work Pass/Fail/NA QCI: Pass/Fail/NA
CO:
Pre-work_________ppm Post-work_________ppm QCI: _________ppm
Efficiency:
Pre-work____________% Post-work____________% QCI:____________%
Gas Leak:
Pre-work Yes/No Post-work Yes/No QCI: Yes/No
Flue Pitch:
Pre-work Pass/Fail Post-work Pass/Fail QCI: Pass/Fail
WC CAZ:
Pre-work _______pa (Pass/Fail) Post work_______pa (Pass/Fail) QCI: _______pa (Pass/Fail)
Draft:
Pre-work _________pa Post-work_________pa QCI:_________pa:
Temperature Rise:
Pre-work___________∘ Post-work__________∘ QCI:___________ ∘
3. Stove
CO:
Pre-work _________ppm Post-work_________ppm QCI: _________ppm
Ambient CO:
Pre-work ___________ppm Post-work___________ppm QCI: ___________ppm
_______________________________________________________________________________________________
ATTIC YES NO N/A
1. Attic Insulation Installed:
2. Good Coverage, LIST R-value
3. Insulation Certificate Completed & Posted
4. Heat Source Damming
5. Exhaust Venting
6. Attic Access Insulated and Secured
7. Energy Related Repairs (List in Comments)
8. Adequate Ventilation
9. Work Meets Standards (Per SWS)
SIDEWALLS & KNEEWALLS YES NO N/A
1. Walls Insulated by WAP
a. Dense-pack method
2. Plugs, Patching, & Painting as appropriate
3. Energy Related Repairs (List in comments)
4. Work Meets Standards (Per SWS)
SUBSPACE YES NO N/A
1. Foundation/Perimeter Insulation added:
Comments – Attic Work
Comments – Subspace
Comments - Sidewalls

4. 2. Floor Insulation added by WAP
3. Basement Wall Insulation by WAP
4. Vapor Barrier added; Coverage & Secure
5. Work Meets Standards (Per SWS)
WINDOWS/DOORS Comments – Windows/Doors
YES NO N/A
1. Need for window replacement documented?
2. Need for door replacement documented?
3. Number of Windows Replaced: ________________
4. Proper Justification
SIR >1.0 Health and Safety
5. Number of Storm Windows Installed: _________
6. Number of Doors Replaced: ____________________
7. Door Weather-stripping/Thresholds/Sweeps
8. Other: Sunscreens /Film ____________
9. Work Meets Standards (Per SWS)
OTHER MEASURES YES NO N/A
1. Water Heater Replacement
2. Water Heater Treatment (Tank Wrap)
3. Pipe Insulation
4. Low Flow Showerheads
5. Lighting - CFLs Installed:____________________
6. Refrigerator Replacement
a. Metering/other documentation:
7. Smoke /Carbon Monoxide Detectors
8. Other H&S Measures (List in comments)
9. Other Energy Related Repairs(Add comments)
10. Other Air Sealing Measures_____________________
11. Other (Describe): ___________________________
12. Work Meets Standards (Per SWS)
OTHER
YES NO N/A
1. Audit discrepancies?
2. Were there missed opportunities?
Describe.
3. Were other programs coordinated in job?
Describe.
Is the Quality Control Inspection for unit complete or is further work required? Complete Incomplete
(*Add comments on additional pages if necessary)
Comments – Other Measures

5. If no, are more in-progress inspections warranted? Yes No
Explain: Are there patterns of non-compliance, health and safety, lead-safe or OSHA concerns?
(*Add comments on additional pages if necessary)
Also, should additional job site documents be reviewed? Yes No
Explain: What documents?
Additional Comments:

6. Call Back Items to be addressed:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Add additional pages if necessary
Recommendation for additional training of contractors/subcontractors:
Company Name_______________________________________________
Phone: _________________________________________________________
Recommended Course: ______________________________________
Quality Control Inspector - Name (Print) ______________________________________________________
Signature: ___________________________________________________________ Date:_____/______/______
By this signature, I acknowledge that my only work in this home was the QC Inspection.
Additional Comments: