Sample Water Audit Forms

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Sample Water Audit
Forms
Sample Water Audit
Forms
BOMA GO-GREEN
Water Audit
Sample 1
Building Information
Building Name___________________________________________________________
Building Address _________________________________________________________
Owner _______________________ (and/or) Manager ____________________________
Age of building ____________________ Size of building ________________________
Type of building: ______________ Major use/s and area of each area type:
Office:
___________ sf
Other (specify:____________ ) __________ sf
Clinic:
___________ sf
Other (specify:____________ ) __________ sf
Warehouse:
___________ sf
Other (specify:____________ ) __________ sf
Retail:
___________ sf
Numbers of permanent occupants: __________________
(optional) Number of Women _____________ Number of Men _______________
Utility/Consumption Data
Water meter/s (utility meters):
Meter #
Size
Area serving
Meter
_________
_________
_________
Meter
_________
_________
_________
Annual water consumption for meter # _____________ consumption ____________
Monthly consumption
Jan
________
Feb
________
March ________
April ________
May
________
June
________
July
________
Aug
________
Sept
________
Oct
________
Nov
________
Dec
________
3
Annual water consumption for meter # ____________ consumption ____________ m
Monthly consumption:
Jan
________
Feb
________
March ________
April ________
May
________
June
________
July
________
Aug
________
Sept
________
Oct
________
Nov
________
Dec
________
Washrooms
Toilets
Tank type:
Number ________@________ Gallons/litres per flush
Number ________@________Gallons/litres per flush
Number ________@________Gallons/litres per flush
Number ________@________ Gallons/litres per flush
Tankless (flushometer equipped):
Number ________@________ Gallons/litres per flush
Number ________@________ Gallons/litres per flush
Number ________@________ Gallons/litres per flush
Urinals
Flush tank:
Number of flush tanks: ________
Capacity of flush tank: ________ Gallons/litres
Number of urinals per tank: ________
Flush interval: ________________
Manual flush:
Number ________@________ Gallons/litres per flush
Number ________@________ Gallons/litres per flush
Number ________@________ Gallons/litres per flush
Sensor flush:
Number ________@________ Gallons/litres per flush
Number ________@________ Gallons/litres per flush
Number ________@________ Gallons/litres per flush
Newer urinals and toilets have the gallons/litres per flush printed on the unit with the name of the
manufacturer. Older toilets and urinals do not. If there is no indication on flush volume, note the
manufacturer and the age of the toilet or urinal. With this information the manufacturer can provide flush
volume information. The volume of the flush can be adjusted on these units. The flushometer manufacturer
can provide the flush volume data or the data may be found in the building maintenance manuals.
Basins/faucets
# of faucets __________ Flow rate __________ gpm/ls
sensor/meter control
# of faucets __________ Flow rate __________ gpm/ls
sensor/meter control
# of faucets __________ Flow rate __________ gpm/ls
sensor/meter control
# of faucets __________ Flow rate __________ gpm/ls
sensor/meter control
Showers
Number of showers
________ Showerhead flow rate ________ gpm/ls
Number of showers
________ Showerhead flow rate ________ gpm/ls
Number of showers
________ Showerhead flow rate ________ gpm/ls
Number of showers
________ Showerhead flow rate ________ gpm/ls
Kitchens/Cafeterias/Lunch rooms
Number of meals served/day: ________
Number of kitchen sinks/ faucets: ________
Are kitchen faucets equipped with aerators? ________
Do spray heads have automatic shut off? ________
Are walk-in refrigerators/freezers water cooled? ________
Are refrigerators equipped with icemakers? ________
Do refrigerators provide drinking water? ________
Are icemakers water cooled? ________
Do kitchens use:
garbage disposals
composting
neither
Is there a dishwasher? ________
Average number of loads per week: ________
Are only full loads washed? ________
Are dishes routinely pre-rinsed prior to wash? ________
Is frozen food routinely thawed under running water? ________
Are kitchen floors hosed clean? ________
How often? ________
Are hoses equipped with high-pressure, water efficient nozzles? ________
Number of Drinking fountains: not cooled ______ water cooled ______ air cooled_____
Number of Vending machines/ coffee makes/ water coolers/ etc. connected to the domestic water system:
________
Number of Ice machines: air cooled________
water cooled________
Mechanical (HVAC) Equipment

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