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Initial Facility Assessment

Company Information:

* = required field Company Name:* Location address where assessment is to be performed:* Contact Name:* Office Phone / Mobile:* Email:*

Breakdown of energy usage in your facility:

(percentage)

Lighting: % Air Conditioning: % Refrigeration: % Equipment: % Resistive: %

Assessment Information:

Does the facility have a significant quantity of non-linear loads? Yes No Does the facility experience any power quality issues? Yes No Does the facility currently have any power factor correction installed? Yes No Do you anticipate adding more shifts or equipment in the next 12 months? Yes No Does the facility have a recurring power factor penalty charge? Yes No Does the facility have significant quantity of medium voltage equipment (greater than 600 volts)? Yes No Average line distance between the meter and average equipment load: ft When was your last lighting retrofit? approx. date Square footage of facility: sq ft Average age of HVAC system and refrigeration units: Does the facility have HVAC energy management system (EMS) installed? Yes No Type of lighting: T12 T8 T5 LED HID Other What is your Power Factor Number coming into the facility? Please upload your past 12 months of bills (max file size 4MB):* FILES SELECTED:

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