Please print and return to Mattew Shields

This will give him a better understanding on how you use your energy

Walk through questionaire

   Client__________________               Contact_________________

   Address________________               Phone #_________________

  City____________________               State_____   Zip__________

1) Electrical usage breakdown

    Please estimate as close as possiable what % of your total electric bill (load) is accounted for by each category.  The total must add up to 100%

a) Lighting                                         ______________%

b) Air conditioning                              ______________%

c) Refrigeration                                  ______________%

d) Hardwired motorized equiptment   ______________%

f) Hardwired Resistive heating/ devices ____________%

                            Total electrical load=         100%

2) Company Information

a) How long has your company been in business?   __________ Years

b) What is the nature of your business?   _______________________________

c) How long has your company been at the current faclity(s) __________Years

d) Have you built an any expantions in the last 5 years ( ) yes    ( ) no

e)Do you plan any building expantions in the next 6 months ? ( ) Yes ( ) No

3) Facility Information

a) Is the facility being charged Power Factor Penalties?  If so How Much_______

b) is the facility being charged for peak demand?  If so how much_________

c)How many electric meters do you have?

e) How many electric panel boxes do you have?

     (consider sub panels an extention of the main panel)

f)  What is the average monthly electric bill for the facility during peak summer months?___________

During peak winter months_____________

Take the average of several summer (winter) months and all meters together) Please include all charges including tax, fuel, ext

g)what is the average KWh_______ per month (use comas)

h) How many square Ft is your faclity?_____________sq ft (use Comas)

i) How many buildings are included in this single site facility? _______ buildings

j) How many shifts do you usually run per day?   1    2   3 

k) Rate your faclitities electrical wiring distrbution system

     Excellent (5)   Very Good (4)  Good (3)  Fair  (2)  Poor  (1)

l) how close is your faclity to reaching electrical capacity?  ______ % of capacity

4) Pre-exissiting Power Correction

a) What % of your lights or equiptment theat turn on and off with motion or infrared detectors?________%

b) What % of your lights have voltage regulators, voltage controlers, or dimmer switches?  _________%

c) What % of motors have capasitors installed on or very close to the motor?  _________%

d) What % of motors have Varaiable Frequency Drives (VFD) installed? ____________%

e) What percent of motors have soft starts installed? ______________%

5) Lighting

a) what is the voltage of your lighting 120v  240v  277v  480v   Other_________

b) What type of lighting is in the business by %?

Incandescent _______%  Flourescent_________%   Hid_________%

c) What % of your lighting is on dedicated circuits _________%

Equiptment Information

a) Do your air conditioners operate with Freon or Ammonia or do you have both types?

b) What % relative to total square footage of your Faclity is air conditioned? ______%

c) How many weeks a year is your facility air conditioned ______

d) How many weeks a year are your facilities heated by electric heat?_______

e) How many space heaters do you have?

f) Approximately how many computers do you have

g) how many refridgerated vending machines do you have?

h) What voltage does your equiptment operate at?  120  240  277  480  Other__________

7) Special equiptment

Please check weather you have any of the following equiptment and approximate the percentage of your total facility electrical load consumed by this equiptment.

a) Synchronous Motors          _______% of Total Motor Load

b) DC motors                        _______% of total motor load

c) Arc Welders                      _______% Of Total electrical load

d) Tig or Mig Welders            _______% of total electrical load

e) Resistive ovens                 _______% of total electrical load

f) Inductive Ovens, Heating or Furnaces  ________% of total electrical load

g) Electroplating or Electrostatic Processes  _______% of total electrical load

h) Rectifiers or DC Chargers    _______% of total electrical load

8 Other special equiptment

a) Mainframe Computer System with dedicated room ( ) Yes   ( ) No

b) UPS system               ( ) Yes   ( ) No

c) Hospital Emergency room  ( ) Yes   ( ) No

Note to surveyors:  Walk thru analysis is processed based upon the information provided.  Analysis will not be sent back for further clarification if information is missing or erroneous.  Inadequate information on the walk thru questionnaire may result in substantial inaccuracies in savings projections, payback or ROI projections.  Answers to non-required fields are helpful in producing this analysis and are esential for producing a project design from a site survey.