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Household Current Conditions
This is a survey/inventory to raise awareness of energy use in a your home.
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THIS FORM IS FOR MR. BURGARD'S CLASSES
Name
*
Your answer
Period
*
Choose
1
2
3
4
5
6
What type of home do you live in?
Single family house
Apartment
Condo
Duplex
Townhome
Mobile home
Other
Electricity Use
Which electrical devices in your home are Energy Star certified? - (choose all that apply)
Audio/Stereo equipment
Computer
Clothes dryer
Dish washer
Heating/cooling system
Microwave
Oven/stove
Television
Clothes Washer
Other
None
Could not find out
Other:
What is the total number of light bulbs you have in your home home?
less than 20
21-30
31-40
41-50
51-60
61-70
71-80
81-90
91-100
more than 100
What percentage of the light bulbs are incandescent?
less than 10%
11-20%
21-30%
31-40%
41-50%
51-60%
61-70%
71-80%
81-90%
90-100%
Not able to do
What percentage of lightbulbs are fluorescent/compact fluorescent?
0-10%
11-20%
21-30%
31-40%'
41-50%
51-60%
61-70%
71-80%
81-90%
91-100%
Not able to do
What percentage of light bulbs are LED?
0-10%
11-20%
31-40%
41-50%
51-60%
61-70%
71-80%
81-90%
91-100%
Not able to do
Heating
What type of home heating system does your residence have? (Mark all that apply)
Electric Wall or baseboard heaters
Gas wall heater
Hot water radiators
Central air (electric)
Central air (gas)
Gas fireplace
Heat pump
Hydroponic (Hot water in the walls or floors)
Passive Solar
Other
Could not find out
What type of water heater do you have?
Electric
Gas
Solar
Other
Do not know
Insulation
How many panes of glasss do you have on your windows?
Single
Double
Triple
Other
What condition is the weather stripping in your home?
Lots of gaps
1
2
3
4
5
No gaps
Clear selection
Which outside door was in the worst condition?
Front door
Porch
Rear door
Door to the garage
All were in good shape
Other:
What type of insulation do you have in your ceiling?
Fibergalss batting
Blown fiberglass
Blown cellulose
Blown wool
None
Can't find out
Other:
Describe what you have learned doing this survey of your house.
Your answer
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