Site Assessment Form

Instructions:

  1. The names and descriptions used here will become the project titles on your proposals, photometrics, etc..
  2. For multiple spaces even within a single facility, use multiple forms.
  3. The x and y facility dimensions must relate to the same x and y orientation as the luminaire layout.
  4. The more information you provide, the more we can help.
form
Prepared By*
Date*
Project/Customer*
Space Description*
Address or Location*

Application*
Select One*
New ConstructionRetrofitOther
Space Dimensions*
by x (ceiling height) in ft.
Layout Dimensions*
Use Existing LayoutLayout is flexibleSuggested X by Y by Z layout
For Existing
by by (bottom of luminaire) in ft.
Existing layout is
Centered on SpaceOffset by and
Layout Comments


Mounting Method
Pipe DropFlush to J-BoxCable/ChainSuspended (T-bar) CeilingOther

Facility Finishes (used in photometric reflectances; skip this if area/site lighting)

Ceiling
Walls
Floor
Other influences (i.e. racks, machinery)
Comments

Existing Luminaire Count
Existing Luminaire Technology
Watts per Bulb
# Bulbs/Luminaire
Existing Lighting Level
at above floor.
Natural light (through windows, skylights, etc.) isis not influencing existing lighting level measurements.
Comments
Desired Lighting Level
at above floor.
Desired Color Temperature  5650K4100KOther
Photocell and/or Occupancy Sensors may apply  YesNo
Other Controls desired

Input Voltage
120-277 V347-480 V

Cost Savings Study information (skip this section if you wish to do your own cost analysis)

Existing kWh rate USD $ or in other currency
Average 5 year rate to use in cost savings study USD $ other currency
Luminaire Unit Price USD $ other currency
Average Daily Hours of Lighting Operation
Customer is interested in leasing
YesNo if Yes, lease term(s) to consider (months): 24364860
Utility Company Rebates Available
YesNo
Customer is a taxpayer and EPAct federal deduction ($0.60/ft2) should be considered YesNo
If yes above, federal income tax bracket to use %

Additional Comments