EIA-871G Worksheet 1 (building version)

Worksheet #1:
Characteristics, Energy Sources and
Equipment (Buildings)
Commercial Buildings Energy Consumption Survey
Sponsored by the U.S Energy Information Administration
Conducted by NORC

The following are some of the topics that will be discussed in the upcoming interview. Having this
worksheet completed and available will facilitate and shorten the interview.
Thinking of calendar year 2007, please provide the following for the building listed above.
Box 1. Gross/Total Square
Footage of Building

Box 2. Number of Businesses or
Organizations in Building

Box 3. Heating Energy Sources
Which energy sources, if any, were used
for heating during 2007?
Check all that apply:
Electricity

(Both finished and unfinished,
including basements, indoor parking
levels, hallways, lobbies, stairways,
and elevator shafts.)

Year of Construction of Building

(If there have been major additions,
provide the year the largest portion of
the building was constructed.)

Box 4. Heating Equipment
Check all that apply:
Furnaces that heat air directly
Packaged central units (roof
mounted)
Boilers inside the building to
produce steam or hot water

Natural Gas

Number of Employees

Fuel Oil/Diesel/Kerosene
Bottled Gas/LPG/Propane
District Steam

(The number of employees that work
in the building during its main shift,
the shift when most employees are in
the building. Include volunteers; do
not include employees who always
work outside of the building.)

District Hot Water
Other (specify)

Which of these was the main energy
source for heating? (Please circle the
energy source used to heat most of the
square footage in the building most of the
time.)

Box 5. Type of Heat Pump Used
for Heating (if applicable)

Box 6. Air Conditioning Energy
Sources

Check all that apply:
Heat Pump System:

Which energy sources, if any, were used
for air conditioning during 2007?

Packaged unit

Check all that apply:

Residential type split system
Individual room heat pump

District steam or hot water piped
into the building from outside the
building

Source Type:
Air source

Heat pumps for heating

Ground source or ground water

Individual space heaters

Water loop

Electricity
Natural Gas
District Chilled Water
Other (specify)

Some other type

Go to Box 7 on the back of this
worksheet
→
Form EIA-871G OMB No.: 1905-0145 Expires: xx/xx/xxxx

Box 7. Cooling Equipment
Check all that apply:
Residential-type central air
conditioners, other than heat
pumps
Packaged air conditioning units,
other than heat pumps
Central chillers inside the building
that chill water for air conditioning
District chilled water piped into the
building from outside the building
Heat pumps for cooling

Box 8. Type of Heat Pump Used
for Cooling (if applicable)
Check all that apply:
Heat Pump System:
Packaged unit
Residential type split system

Box 9. Ventilation and
Distribution Equipment for
Heating and Cooling
Indicate all that apply:
B—heating and cooling
H—heating only
C—cooling only

Individual room heat pump
No mechanical ventilation (outside
air) equipment

Source Type:
Air source
Ground source or ground water
Water loop

Individual room air conditioners
other than heat pumps

Central air-handling unit(s) with
outside air system and constant
air volume (CAV) control
Central air-handling unit(s) with
outside air system and variable
air volume (VAV) control

“Swamp coolers” or evaporative
coolers

Packaged unit(s) with outside air
damper

Some other type

Through-the-wall packaged units

Box 10. Water Heating Energy
Sources

Box 11. Cooking Energy Sources

Which energy sources, if any, were used
for water heating during 2007?

Which energy sources, if any, were used
for cooking during 2007?

Check all that apply:

Check all that apply:
Electricity

Natural Gas

Natural Gas

Fuel Oil/Diesel/Kerosene

Fuel Oil/Diesel/Kerosene

Bottled Gas/LPG/Propane

Bottled Gas/LPG/Propane

Other (specify)

Other (specify)

Which energy sources, if any, were used
for on-site electricity generation during
2007?
Check all that apply:
Natural Gas

Hot water/steam radiators
Fan-coil units
Stand-alone exhaust fan (relief
blower)
Ceiling fan(s)

Electricity

Box 12. Sources for On-Site
Electricity Generation

Dedicated 100% outside air system

Box 13. Office Equipment

Box 14. Lighting Equipment

Check all that apply and indicate number
used in the building during 2007:

Was any of the square footage in this
building lit by the following during 2007?
Check all that apply:

Number:
Computers
Laptop computers
Dedicated servers

Fluorescent lighting other than
compact fluorescent light bulbs
Compact fluorescent bulbs

Printers

Incandescent bulbs, other than
halogen bulbs

Photocopiers

Halogen bulbs

Cash registers

Solar

High intensity discharge (HID)
lights, such as high pressure sodium,
metal halide, or mercury vapor

Other (specify)

LED (light emitting diode) lights

Fuel Oil/ Diesel/ Kerosene
Bottled Gas/ LPG/Propane
Wood
Coal

Other (specify)