Sample Water Audit Forms Page 9
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15Water Audit Guide
Sample 2
This data collection guide is designed to help you analyze water use in your facility.
Some items may not apply to all facilities.
Agency: _________________________________________________________________
Facility Name: ____________________________________________________________
Address: ________________________________________________________________
Date of Assessment: _________________________
Audit Coordinator(s): ___________________________________________________________
Assessment Team Members: ______________________________________________________
As you tour your facility and consider each point of water consumption, determine whether each use is essential or
non-essential. Check the box in the left column to mark essential uses.
Background
Baseline water usage: __________________________________________________________
Local water provider: __________________________________________________________
Where does your water come from? _______________________________________________
Number of buildings at facility: ______________
Size of buildings (area): ____________
Area of grounds: ______________
Size of motor pool (# of vehicles): _____________
Number of employees per shift: _________ Number of shifts per day: _________
Average number of visitors/occupants per day (if applicable): __________
Water pressure at your facility: _________________ (psi)
(Often reducing water pressure by merely 10 or 15 percent can reduce water consumption significantly without interfering
in daily consumption activities. Water pressure that is too high can result in leaks.)
❑ Yes
❑ No
Does staff have good general water conservation awareness habits?
❑ Yes
❑ No
Have you ever had a water-balance or leak-check?
(Entails shutting off all known water usage. If the meter records any water usage during this period, you have a leak or
undocumented consumption.)
Is there an on-site water treatment facility? ❑ Yes
❑ No
If so, give a brief description of the facility, flow rates, chemical additions, and average cost (per unit
volume).
❑ Yes
❑ No
Is there an on-site wastewater treatment facility?
If so, give a brief description of the facility, flow rates, chemical additions, and average cost (per unit
volume).
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