LOUISIANA HOUSING CORPORATION
WEATHERIZATION ASSISTANCE PROGRAM
QUALITY CONTROL FINAL INSPECTION (QCI) FORM
Grantee: Subgrantee:
Job #: Completed/Date of Completion
Agency Inspector: Client name: Owner Renter
City/ Street: Pre-1979 Home: Yes No
Housing Type: Single Family Mobile Home Multi-Family Shelter
Primary Fuel Type: Natural Gas Propane Electric Oil Other:
FILE REVIEW YES NO N/A Comments- File
1. Eligibility De termination Present?
2. Energy Audit Priority List
3. Work Order/ Building Weatherization Report
4. Work Agreement
5. Lead-Paint Notification Documented
6. Certified Renovator Documentation
7. Lead Safe Weatherization Documentation
8. Mold/Moisture Form Documentation
9. Other Hazardous Notification Form
10. State Historic Preservation Documentation
11. Combustion Appliance Safety Tests
12. Pre & Post Combustion Safety Tests
13. Pre & Post Blower Door Result (@CFM 50)
Pre #: Post #:
14. Final Inspection Form Signed
15. Reworks Required by Sub grantee
16. Client Satisfaction Signed/Dated
17. Other (Describe):
ON-SITE WORK ASSESSMENT
HEATING, VENTILATION, AIR CONDITIONING Comments- HVAC
1. Heating System Replacement
2. Air Conditioning Replacement
3. Heating System Tune-Up/ Filter
4. Air Conditioning Tune-Up/ Filter
5. Duct Sealing
6. Set-Back Thermostat
ATTIC Comments- Attic Work
1. Attic Insulation Installed:
2. Good Coverage R-value
3. Insulation Certificate Completed & Posted
4. Heat Source / Vent Damming
5. Attic Access Insulated and Secured
6. Energy Related Repairs
7. Work Meets Standards
SIDEWALLS & KNEEWALLS YES NO N/A Comments – Sidewalls
1. Walls Insulated by WAP
a. Dense-pack method
2. Plugs, Patching, & Painting appropriate
3. Energy Related Repairs:
4. Work Meets Standards
SUBSPACE Comments – Subspace
1. Foundation/ Perimeter Insulation added:
2. Floor Insulation added by WAP
3. Basement Wall Insulation by WAP
4. Vapor Barrier added; Coverage & Secure
5. Work Meets Standards
WINDOWS/DOORS Comments – Windows/Doors
1. Number of Windows Replaced:
2. Proper Justification
3. Number of Storm Windows Installed:
4. Number of Doors Replaced:
5. Door Weather-stripping/Threshold/Sweeps
6. Other: Sunscreens / Film
7. Work Meets Standards
OTHER MEASURES Comment – Other Measures
1. Water Heater Replacement
2. Water Heater Treatment (Tank Wrap)
3. Pipe Insulation
4. HVAC filters
5. Low Flow Shower Heads
6. Lighting – CFLs Installed:
7. Refrigerator Replacement
i. Metering/ other Documentation
8. Smoke /Carbon Monoxide Detectors
9. Other H&S Measures
10. Other Energy Related Repairs
11. Air Sealing Measures
12. Other (Describe):
13. Work Meets Standards
Unit needs additional attention from the agency? YES NO
Notes and Re-Works (Add comments on additional pages if necessary):
I certify that I have performed a final inspection on the dwelling unit identified above and determined that it has met or
exceeded every requirement of DOE’s Standard Work Specification and the Louisiana Field Guide for Weatherization.
QCI Assessor Name (Print): BPI QCI Number:
QCI Signature: QCI Inspection Date: / / _