Refrigerator General Information Replace -- Other funding source Manufacturer: Replace Evaluate w/DOE – Size (cu ft): Style: Age: Door Seal: 14 Top Freezer < 5 10-15 Good 15 Bottom Freezer 5-9 >15 Fair 16 Side by Side Poor 17 Single Door Comments: 18 Single Door w/ Freezer 21 Other Other: Defrost: Location: Auto Heated Space Manual Unconditioned Space Unintentionally Heated Health and Safety Alarms ALARM CO ALARM Location Working Install New Location Working Install New < 5 years < 5 years Total Smoke to Install: SMOKE/CO ALARM CO to Install: Total COMBO Smoke/CO: Comments:
Refrigerator General Information Replace -- Other funding source Replace – Evaluate w/DOE Manufacturer: Size (cu ft): 14 15 16 17 18 21 Other: Location: Heated Space Unconditioned Space Unintentionally Heated Style: Top Freezer Bottom Freezer Side by Side Single Door Single Door w/ Freezer Other Defrost: Auto Manual Age: < 5 5-9 10-15 >15 Door Seal: Good Fair Poor Comments: Health and Safety Alarms ALARM CO ALARM Location Working < 5 years Install New Location Working < 5 years Install New SMOKE/CO ALARM Total Smoke to Install: CO to Install: Total COMBO Smoke/CO: Comments:
audit-data-collect-py15-option.docx