Montana Weatherization Program WEATHERIZATION FINAL INSPECTION REPORT (Mobile Homes) Client Name Address Contact phone # Inspector Name and QCI#

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1 EA #. Date Priority # HEALTH & SAFETY Hazardous Material Assessment Electrical Repairs Performed by Licensed Professional Solid Fuel Burning Appliance CO Detection/Warning, Occupant Education, # Installed. Montana Weatherization Program WEATHERIZATION FINAL REPORT (Mobile Homes) Client Name Address Contact phone # Inspector Name and QCI# FINAL RE Section a f c d,e e,f h DWH Closet Isolation Pier, Skirting Venting Smoke Alarm, # Installed Moisture Precautions Ground Moisture Barrier COMBUSTION TESTING Combustion Safety D Furnace f Testing/Diagnostics W /Boiler a,b Documentation H g Spillage Test Failure? Undiluted Flue CO: SS Efficiency: Outdoor Temp: Notes: Ambient CO Monitored (>35 PPM) Combustible Gas Leak Detection Visual Inspection of Appliance(s) CAZ Depressurization Test (Atmospheric Draft) Gas, LP Range Oven Test f e b c d,e d e

2 CAZ Depressurization Limit Appropriate for Installed Appliance Adequate Combustion Air (Atmospheric Draft) Complete Heating Worksheet (EAP-008) FINAL RE d,e c,d AIR SEALING Section 3 Attic Walls Windows, Doors Belly, Floor Ducts Duct Test Results Present b d Additions INSULATION Section 4 Insulation Certificate And Location Attic Above Roof Deck Insulation Insulation In Lid g h Insulation (Roof Over Construction) Roof Sealing Wall Insulate Transition Wall Exterior Wall Dense Packing Stuffing Fiberglass Batts (Wall) (Lift Siding) Through Wall Penetrations SPF in Cavities Above Door And Windows Belly Belly Insulation Prep Blown Floor Insulation Batt Floor Insulation

3 FINAL RE SPF Floor Insulation Basement Wall Insulation (No Ground Water Leakage) Water Line Protection/ Heat Tape Duct Insulation HEATING Visual assessment, data plate verification System airflow assessment Refrigerant line inspection (heat pump) Mobile Home approved furnace, solid fuel heat source Heating Controls, Thermostat Refrigerant charge evaluation (Heat Pump) appliance serial number confirmed Section a b Ventilation Section 6 Exhaust Ventilation Ducts (exhaust fan) Surface mounted In-line fan Fan placement Clothes dryer Kitchen range Supply Ventilation Complete ASHRAE Information in File? Nominal continuous ventilation fan setting: Run time setting: Notes: Exhaust Fan Flows: Kitchen1: Whole House: Kitchen2: : Bath1: Bath2: Bath3: h g f

4 FINAL RE BASELOAD Section 7 Refrigerator, Freezer LED s Installed, # CFL s Installed, # Washing Machine (BPA Only) Clothes Dryer Shower Head, Faucet Aeration DWH Selection, Mobile Home Approved DWH Installation DWH Maintenance Water Heater Insulation Pipe Insulation Aerator, Showerhead Water Temp. Checked? Home Left Clean, Replaced Appliances Removed i c c,i h c b b INCIDENTAL REPAIRS Window Repair Primary Window Storm Window /Install Door Repair Door MINOR REPAIRS Plumbing Leaks? Electrical Problems? CLIENT EDUCATION EES Report Operating Instructions for Fans or Thermostats. Manuals Maintenance Instructions Client Informed of Funding Source? Hazardous Conditions Noted During Weatherization?

5 Lead Documentation Present in Client File Pre-Retrofit Target Post Final Inspection SWS Ref. Blower Door Values Zone Pressure Test: Attic A DHW Closet Client s Acknowledgement of Final Inspection and Receipt of Required Literature A final inspection of the weatherization work was completed on my home; I am satisfied with the work and I have received all required literature related to the weatherization process. CLIENT S SIGNATURE Final Inspector s Acknowledgement A final inspection was completed on the home and all weatherization and health and safety measures were completed or have been addressed to the best my knowledge. INSPECTOR S SIGNATURE Re-Inspection Acknowledgements Measures that did not meet the Standardized Work Specifications that were brought into compliance to the best my knowledge. CLIENT S SIGNATURE INSPECTOR S SIGNATURE

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