Weatherization Manual Policies and Procedures Supporting Documents for United States Department of Energy (doe) United States Department of Health and Human Services (hhs) Bonneville Power Administration

Solid Fuel Burning Appliance Systems Supplemental Audit Form

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Solid Fuel Burning Appliance Systems Supplemental Audit Form

Complete this form and place in client file.

1. Is the system the primary heat source? Yes____ No_____

2. What are the existing conditions of the system?





Health & Safety Concerns


Inefficient & life span less than one year

Chimney/flue system

Wood heating unit

Surrounding area (hearth, clearances, location)

3. Describe recommended measure for existing situation:

4. What is your recommendation, based on cost and nature of the problem?

Repair Replace

5. Who is making this recommendation?

Agency Representative Heating System Subcontractor

I certify that the above information is complete and accurate.

Signature of Agency Representative Date

Client Information: I have received information on safe operation, proper maintenance, and clean burning for my new (or repaired) solid fuel burning appliance system.

Client Signature Date

Link to Active Form: Exhibit 5.1.6A, Economic Analysis of Refrigerator Replacement

Variance #20 – SWS Section 7.8001.1a

Variance #20: DOE granted a variance from SWS Section 7.8001.1a Refrigerator & Freezer Replacement allowing: WA allows Energy Star rated or equivalent energy use Refrigerator replacements. DOE prohibits Freezer replacements.

Link to Active Form:

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