Pool & Spa Assessment Form - Free Hot Water

_____________________________________________________________________________
Pool & Spa Assessment Form
Building owner/user: _______________________________
Address: _________________________________________
Date:__________________
Building: __________________________
City, State, Zip ______________________________________ Phone: ________________
Solar Application: ___ Pool Only ___ Spa Only ___ DHW Pool Combination ____ Pool & Spa
Reason For Interest (rank in order):
___ Promotion of renewable energy/conservation of fossil fuel ___ Save money ___ Own a solar System
Expected Solar Savings: ___ Pool Only ___ Spa Only ___ DHW combination ___ Pool & Spa
Pool & Spa: Have Pool _____ Yes _____ No
Spa _____ Yes _____ No
Pool Size _____ Length x _____ Width _____ Depth Pool Sq.Ft. _____ Spa Size _________ Spa Sq.Ft. ____
Desired Temp _____ Pool _____ Spa Is pool shaded? ___ Yes ___ No If shaded, what percentage? _____
Is pool in a windy area? _____
Check swimming season:
Jan _____ Feb _____ Mar_____ Apr _____ May _____ Jun _____
Jul _____ Aug _____ Sep_____ Oct _____ Nov _____ Dec _____
Total Annual Load/ $ spent : ______________________
Available roof space sq. ft. _____
Pitched roof _____ Flat roof _____
Pool panels desired Plastic ____ Glass flat plates _____
Rack mounted ____ Roof mounted ____ Ground mounted ___
Highest point of collector _____
How far is the pool equiptment room from the collectors _____
Currently have pool controller? ___ Yes ___ No
Notes: _________________________________________________________
______________________________________________________________________________
2146 Bering Drive San Jose, CA 95131 Tel: 408 432-9900 Fax 408 872 4142 www.FreeHotWater.com

Use the Layout above to do a sketch of the roof outline, including vents, chimney, satellite etc…
Measure from the outside of the roof edge to the location of the proposed panels.