Sample Water Audit Forms Page 10

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Sample Water Audit Forms Printable pdf

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Size, type, and location of water meter(s): ___________________________________________ Size, type,

and location of wastewater meter(s): _______________________________________

Describe the amount, location, and use of untreated groundwater if you use it at your facility:

_____________________________________________________________________________

What, if any, water efficiency measures are already in place? ____________________________

_______________________________________________________________________________________

_____________________________________________________________________

Personal Water Consumption

Number of restrooms: _______

Number of toilets (total): _______

Note: Many fixtures have the average flow rate printed on the fixture itself, along with the make and model. If you

cannot find this printed information, consult your maintenance staff or facility manager.

Type of toilets and average water consumption in gallons per flush (gpf):

*Note: Most toilets are either gravity flush, flush valve/flushometer/tankless, or pressurized tank types.

Toilet type: ______________

Number: ______

Average gpf: _____

Toilet type: ______________

Number: ______

Average gpf: _____

Urinal model: ____________

Number: ______

Average gpf: _____

❑ Yes

❑ No

Are toilets equipped with toilet dams or low-flow flapper valves?

❑ Yes

❑ No

Do flush valve (tankless) toilets have water-saving diaphragms?

❑ Yes

❑ No

Are toilets equipped with automatic water-flushing systems?

If so, what is the timing cycle? _______

❑ Yes

❑ No

Are the sensors/timers coordinated with regular work hours?

Total water consumption per workday from toilet flushes: _________

* Assuming each employee/occupant uses the bathroom 4x per workday

Number of restroom faucets (total): _______

Faucet flow rate: ________ gpm

❑ Yes

❑ No

Are faucets equipped with aerators?

Are faucets equipped with automatic or metered shutoff mechanisms? ❑ Yes

❑ No

Number of showers (total): ______

Showerhead flow rate: _________ gpm

Number of drinking fountains: _____

Fountain flow: _____ gpm

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