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Community Energy Services Home Visit Survey

Thank you for participating in Community Energy Services! As part of our ongoing commitment to improving this pilot program, we are asking you to take a few minutes to complete this brief survey about your experience at your home visit today. All questions are confidential in line with our privacy policy. Thank you – your input is very valuable!

1. Counselor's Name:

2. Technician's Name:

3. Please indicate your level of agreement with the following statements:

Space Cell	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
I learned more about my home's energy use at the home visit
The crew clearly explained the home visit process
The crew presented information clearly and explained their recommendations for improvements (if any)
The crew let me know that financing and rebates are available
The crew involved me in the home visit process
I would recommend a CES home visit to others
I am planning on implementing our energy saving recommendations (i.e. attic insulation, new furnace, etc).

4. Overall, how satisfied are you with your home visit?

5. Would you like to be contacted with information about rebates, contractors and/or financing?

6. Overall, what did you like most about the home visit? What do you think could be improved? Do you have any other feedback?

7. Contact information (optional)

First Name

Last Name

Street Address

Zip

Email Address

Daytime Phone Number