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