2 3

19 9 8 7 6 5 4 3 2 1

18

17

16

15

14

13

12

11

4 5 6 7 8 9 10

40 30 41 42

39 29

38 28

37 27

36 26

35 25

34 24

33 23

32 22

31 21

30 20

29 19

28 18

27 17

26 16

25 15

24 14

23 13

22 12

21 11

20 10

Item #

Field Survey Form

type of fuel

pipe or tube material (steel, copper etc.)

NIA Mechanical Insulation Appraisal

insulation type ASTM# or name

NAIMA 3E Plus Program

jacket material & description

vertical or horizontal

source efficiency percent (enter whole number)

hours of operation per year

fuel heat cont. in Btu

cost of fuel to source caution check units

$/kwh $/Mft3, $/gal, $/ton

process Temp F

avg. ambient temp F

relative humidity (cold pipes) wind speed MPH

pipe/tube size

Page 1 of 4

inventoried insulation thickness inches

Process Identification (list individual system components)

C D E F G H I J K L M N O

Date:

Location: EXPLANATION OF IMBEDDED CALCULATIONS

P Q

quantity SF or LF

T 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

20 10 21 11 22 12 23 13 24 14 25 15 26 16 27 17 28 18 29 19 30 20 31 21 32 22 33 23 34 24 35 25 36 26 37 27 38 28 39 29 40 30 41 42

Item #
1 2 3 4 5 6 7 8 9

U 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

AA

AB

AC

AD

AE

AF

AG 0

AH

AI

AJ

AK

AL

NIA Mechanical Insulation Appraisal

Energy Cost Report NAIMA 3E Plus Program

Date: Location:

Page 2 of 4

EXPLANATION OF IMBEDDED CALCULATIONS HIDDEN HIDDEN COLUMN COLUMN $$ SAVINGS $$ energy loss energy cost (cost to run bare Energy Loss to op ins. to op ins. surface less cost for item Energy Loss item with item with for inventoried assuming to run surface
x inches $ / yr R*AD

Item #

3E+ Heat 3E+ Heat Energy assuming bare Loss for Loss Cost to surface is bare inventoried operate w/ insulated with inventoried insulated bare x inches surface system &/or bare Btu / ft / yr Btu / ft / yr Btu / ft / yr $ / ft / yr

3E+ Heat Loss

Energy Cost to operate inventoried Energy Cost bare &/or to operate w/ insulated bare surface surfaces $ / yr $ / ft / yr Z*R AB

Energy Cost to operate inventoried bare & insulated surfaces $ / yr AB*R

Energy Cost to operate insulated

BTU SAVINGS (energy loss from bare system less

item with
x inches

energy loss if
insulated with x Btu / yr AI-AF

of insulation
$ / ft / yr

inches
Btu / yr R*X

inches

item insulated & bare Btu / yr W*R

entire surface is bare Btu / yr V*R

insulated with x inches) $ / yr AA-AG

1 2 3 4 5 6 7 8 9

AD

col AH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Totals
SUM col AA

col AI

col AJ

col AL

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
SUM col AC

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 SUM col AH 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 SUM col AI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUM col AJ 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 0.00E+00 SUM col AL

20 10 21 11 22 12 23 13 24 14 25 15 26 16 27 17 28 18 29 19 30 20 31 21 32 22 33 23 34 24 35 25 36 26 37 27 38 28 39 29 40 30 41 42

AM

AN

Page12 of 4
2 3
BTU 4 SAVINGS (energy 5 loss from bare6 system less

energy 7 loss if insulated 8 with 9 inches) 10 Btu / yr 11 AI-AF 12 col AL 13 14 0.00E+00 15 0.00E+00 16 0.00E+00 17 0.00E+00 18 0.00E+00 19 0.00E+00 20 0.00E+00 21 0.00E+00 22 0.00E+00 23 0.00E+00 24 0.00E+00 25 0.00E+00 26 0.00E+00 27 0.00E+00 28 0.00E+00 29 0.00E+00 30 0.00E+00 31 0.00E+00 32 0.00E+00 33 0.00E+00 34 0.00E+00 35 0.00E+00 36 0.00E+00 37 0.00E+00 38 0.00E+00 39 0.00E+00 40 SUM 41 col AL 42

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Item #
1 2 3 4 5 6 7 8 9

AO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

AP

AQ

AR

AS

AT

AU

AV

AW

AX

AY

AZ

BA

BB

BC

BD

NIA Mechanical Insulation Appraisal

Environmental Report
Emissions Assuming All Surfaces Are Bare

Date: Location: EXPLANATION OF IMBEDDED CALCULATIONS Current Savings (emissions from bare

Page 3 of 4

NAIMA 3E Plus Program

Emissions From Inventoried (current) Surfaces

Emissions Assuming Bare Surfaces Insulated With

Potential Savings (emissions from bare

surfaces minus emissions from surfaces surfaces with x of insulation)

Item #

surfaces minus emissions from inventoried inches of Insulation surfaces)

CO2
LBs / ft / yr

NOx
LBs / ft / yr

CE
LBs / ft / yr

CO2
LBs / ft / yr

NOx
LBs / ft / yr

CE
LBs / ft / yr

CO2
LBs / ft / yr

NOx
LBs / ft / yr

CE
LBs / ft / yr

CO2
LBs / yr (R*AP)-(R*AS)

NOx
LBs / yr (R*AQ)-(R*AT)

CE
LBs / yr (R*AR)-(R*AU)

CO2
LBs / yr (R*AP)-(R*AV)

NOx
LBs / yr

CE
LBs / yr

1 2 3 4 5 6 7 8 9

AP

AQ

AR

AS

AT

AU

AV

AW

AX

(R*AQ)-(R*AW) (R*AR)-(R*AX)

col AY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Totals 0 SUM col AY

col AZ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUM col AZ

col BA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUM col BA

col BB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUM col BB

col BC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUM col BC

col BD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUM col BD

20 10 21 11 22 12 23 13 24 14 25 15 26 16 27 17 28 18 29 19 30 20 31 21 32 22 33 23 34 24 35 25 36 26 37 27 38 28 39 29 40 30 41 42

BE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

20 10 21 11 22 12 23 13 24 14 25 15 26 16 27 17 28 18 29 19 30 20 31 21 32 22 33 23 34 24 35 25 36 26 37 27 38 28 39 29 40 30 41 42

Item #
1 2 3 4 5 6 7 8 9

BF 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42

BG

BH BI BJ BK BL BMBNBO BP BQBR BS BT BU BVBWBX BY BZ CA CBCCCDCE CFCGCH CI CJ CK CL CMCNCOCPCQCRCS CT CUCVCWCX CY CZ DA DBDCDDDE DFDGDH DI DJ DK

NIA Mechanical Insulation Appraisal

Summary Report NAIMA 3E Plus Program

Page 4 of 4

Date: 0.00 Location: EXPLANATION OF IMBEDDED CALCULATIONS

The following data was calculated using the NAIMA 3E Plus (version 3.0) computer program. The existing insulation on the system saves approximately If the insulation on the system was increased to x
SUM col AI - SUM col AH

Btus of energy and SUM col AA - SUM col AC

annually. SUM col AJ annually.

inches the system would save approximately

SUM col AL Btus of energy and

(note: this would be the total savings attributable to the insulation -this is not additional savings from upgrading the insulation)

Energy in BTUs
Cost to operate (inventoried) bare surfaces per year =

Dollars SUM col AA SUM col AC SUM col AG CO2

SUM col AA - SUM col AC

SUM col AI SUM col AH SUM col AF

SUM col AI - SUM col AH

Cost to operate (inventoried) bare & insulated surfaces as currently installed = Cost to operate (inventoried) surfaces installed with x inch thick insulation =

Pounds NOx SUM col AZ SUM col BC CE SUM col BA SUM col BD SUM col AY SUM col BB

Savings with the use of current (inventoried) insulation versus no insulation = Total potential savings assuming Additional potential savings assuming x x in. insulation versus no insulation = in. insulation vs.current inventory =

SUM col AI - SUM col AF

SUM col AA - SUM col AG

SUM col AH - SUM col AF

SUM col AC - SUM col AG

SUM BB - SUM AY SUM BC - SUM AZ SUM BD - SUM BA