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 Construction Retrofit Other
Space Dimensions*
by x (ceiling height) in ft.
Layout Dimensions*
 Use Existing Layout Layout is flexible Suggested X by Y by Z layout
For Existing
by by (bottom of luminaire) in ft.
Existing layout is
 Centered on Space Offset by and
Layout Comments


Mounting Method
 Pipe Drop Flush to J-Box Cable/Chain Suspended (T-bar) Ceiling Other

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.)  is is not influencing existing lighting level measurements.
Comments
Desired Lighting Level
at above floor.
Desired Color Temperature   5650K 4100K Other
Photocell and/or Occupancy Sensors may apply   Yes No
Other Controls desired

Input Voltage
 120-277 V 347-480 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
 Yes No if Yes, lease term(s) to consider (months):  24 36 48 60
Utility Company Rebates Available
 Yes No
Customer is a taxpayer and EPAct federal deduction ($0.60/ft2) should be considered  Yes No
If yes above, federal income tax bracket to use %

Additional Comments