                                                      OMB Control No. 2060-0347
Appendix 3:  PE Verification Checklist
Plant:  ____________________________________________________________________

Date:  ________________

PE:  ______________________________________________________________________

Review location:  ___ Corporate Office  ___ Site Visit 

Plant Physical Characteristics and Eligibility

   oo    The plant has established a formal certification file.  Yes___ No___  If so, where? _____________________________
   oo    The plant's activities conform to the eligibility description in the EPI Instructions. Yes___ No___  
   oo These plant activities are described in the certification file. Yes___ No___
   oo    Relevant calculations of plant activities (e.g., space requirements) meet specified minimums in the EPI Instructions.  Yes___ No___
   oo These plant calculations supporting eligibility are documented in the certification file.  Yes___ No___
Plant Operating Characteristics

   oo    All data are confirmed to belong to the plant named in the EPI and plant certification documents. Yes___ No___
   oo    All data are confirmed to match the same 12-month time period specified on the Statement of Energy Performance. Yes___ No___
   oo    The plant's data is current (defined as within 4 months of the Period Ending Date on the Statement of Energy Performance).  Yes___ No___
   oo    All original source data (e.g., production records) has been reviewed to assure all data were correctly transcribed into a spreadsheet, database, etc.  Yes___ No___
        oo       If original source data are not available for review, it can be verified that appropriate internal verification procedures are applied to any company databases used for applicable data.  Yes___ No___
   oo    All calculations made using the original source data have been reviewed to assure accuracy, correct conversion of units, and use of generally accepted and uniformly applied conversion factors. Yes___ No___
   oo    Annual totals resulting from all calculations match the values entered into the EPI.  Yes___ No___
   oo    Annual totals resulting from all calculations match the units specified in the EPI.  Yes___ No___
   oo    Inputs or calculations for other required plant physical characteristics (e.g., square footage, kilns) are consistent with source documents provided in the certification file.  Yes___ No___
   oo    All source data, calculations, and assumptions have been documented in the formal certification file.  Yes___ No___    
   Note that referral to a company database is not adequate; the file must include a static record of data drawn from the database on the date of EPI completion (i.e., the date the EPI score and Statement of Energy Performance were produced).   
   
   oo    All production metrics (e.g., quantities, capacities, labor hours) follow the procedure specified in the EPI instructions. Yes___ No___
   oo    Source data, calculations, and documentation for all other data types (e.g. HDD/CDD) have been reviewed and documented in the formal certification file.  Yes___ No___

Energy Data

   oo    All data confirmed to belong to the plant are named in the EPI and plant certification documents.  Yes___ No___
   oo    All data confirmed to match the same 12-month time period are specified on the Statement of Energy Performance.  Yes___ No___
   oo    The plant's data are current (defined as within 4 months of the Period Ending Date on the Statement of Energy Performance. Yes___ No___
   oo    All original source data (e.g., utility invoices) have been reviewed to assure all data were correctly transcribed into a spreadsheet, database, etc.  Yes___ No___
   oo If original source data are not available for review, it can be verified that appropriate internal verification procedures are applied to any company databases used for applicable data. Yes___ No___
   oo    All calculations made using the original source data have been reviewed to assure accuracy, correct conversion of units, and use of generally accepted and uniformly applied conversion factors.  Yes___ No___
   oo    Annual totals resulting from all calculations match the values entered into the EPI.  Yes___ No___
   oo    All source data, calculations, and assumptions have been documented in the formal certification file.  Yes___ No___    
   Note that referral to a company database is not adequate; the file must include a static record of data drawn from the database on the date of EPI completion (i.e., the date the EPI score and Statement of Energy Performance were produced).   
   oo    Annual totals resulting from all calculations match the units specified in the EPI.  Yes___ No___
   oo    All energy sources used at the plant are included in the EPI.  Yes___ No___
   oo    All energy sources follow the energy accounting procedure specified in the EPI instructions.  Yes___ No___
   oo    Calculations for energy transfers (purchased steam, compressed air) have been reviewed for accuracy.  Yes___ No___
   
ENERGY STAR Energy Performance Score

   oo    All the required data have been entered into the EPI.  Yes___ No___
   oo    The data have been properly entered into the EPI.  Yes___ No___
   oo    The plant's EPI score is 75 or higher.  Yes___ No___
PE Verification

   *    The PE review of the plant has been documented (e.g., site visit vs. corporate office, date, personnel met with, findings/corrections/recommendations from the review).  Yes___ No___
   *    The PE completed the Verification Checklist for submission to EPA, and added the original document to the formal certification file.  Yes___ No___
   *    The PE signed, stamped  -  indicating if embossed, and provided the required license information on the Statement of Energy Performance for submission to EPA, and added the original document to the formal certification file.  Yes___ No___
   
   
Please note any company personnel involved in review:





Please note any findings, corrections, or recommendations from the review:






































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