EIA-871G Worksheet 1 (Building Version)

Commercial Building Energy Consumption Survey (CBECS)

2012 CBECS - Form 871G - Worksheet 1

Commercial Building Energy Consumption Survey (CBECS)

OMB: 1905-0145

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Worksheet #1:

Characteristics, Energy Sources and Equipment (Buildings)



Commercial Buildings Energy Consumption Survey

Sponsored by the U.S. Energy Information Administration

Conducted by Westat

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 2012, please provide the following for the building listed above:

Box 1. Gross/Total Square Footage of Building






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


Year of Construction of Building





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

Box 2. Number of Businesses or Organizations in Building






Number of Employees





(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.)

Box 3. Heating Energy Sources


Which energy sources, if any, were used for heating during 2012?


Check all that apply:



Electricity




Natural Gas




Fuel oil/Diesel/Kerosene




Bottled Gas/LPG/Propane




District Steam




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 4. Heating Equipment


Check all that apply:


Furnaces that heat air directly




Packaged units (roof mounted)




Boilers inside the building to


produce steam or hot water




District steam or hot water piped


into the building from outside the


building




Heat pumps for heating




Individual space heaters




Some other type (specify)






Box 5. Type of Packaged Heating (if applicable)


Check all that apply:


Type of Packaged Unit(s)



Unitary packaged unit




Custom built-up unit



Heating Component of Packaged

Unit(s)




Furnace




Heat Pump




Heating Coil




Powered induction unit (PIU)




Duct reheat



Box 6. Boiler or District Steam/
Hot Water Heat Distribution System
(if applicable)


Check all that apply:



Radiators




Fan coil units




Induction units




Water loop heat pump




Central air handler (hydronic/steam


coils)




Packaged unit (hydronic/steam coils)




Duct reheat (hydronic/steam coils)





Go to Box 7

Form EIA-871G OMB No.: 1905-0145 Expires: 09/30/20xx

Box 7. Type of Heat Pump Used for Heating (if applicable)


Check all that apply:



Heat Pump System




Packaged unit (roof mounted)




Split system (residential-type)




Individual room heat pump



(packaged terminal heat pump)






Ductless mini-split system




Variable refrigerant flow (VRF)



Type of Heat Pump




Air source





Ground source or ground water


(geothermal)




Dual source (combination of air



source and geothermal)




Water loop


Box 8. Individual Space Heater
(if applicable)


Check all that apply:



Infrared radiant heater (permanent)




Baseboard heater (permanent)




Portable space heater




Wall heater




Individual furnace




Unit heater




Heating element (electric resistance)


in packaged terminal air conditioner


(PTAC)


Box 9. Cooling Energy Sources


Which energy sources, if any, were used for cooling during 2012?


Check all that apply:



Electricity




Natural Gas




District Chilled Water




Other (specify)





: heating only;erng to 00000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000

Box 10. 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




Individual room air conditioners,


other than heat pumps




Swamp coolers” or evaporative


coolers




Some other type (specify)






Box 11. Type of Packaged Cooling (if applicable)


Check all that apply:



Type of Packaged Unit(s)




Unitary packaged unit




Custom built-up unit



Box 12. Type of Chiller

(if applicable)


Check all that apply:



Type of Chiller




Air-cooled




Water-cooled




Absorption




Can operate as heater chiller


Box 13. Chiller or District Chilled Water Distribution System (if applicable)


Check all that apply:



Central air handler (hydronic coils)




Fan coil units




Induction units




Water loop heat pump




Chilled beam




Packaged unit (hydronic coils)




Duct reheat (hydronic coils)


Box 14. Type of Heat Pump Used for Cooling (if applicable)


Check all that apply:



Heat Pump System




Packaged unit (roof mounted)




Split system (residential-type)




Individual room heat pump



(packaged terminal heat pump)






Ductless mini-split system




Variable refrigerant flow (VRF)



Type of Heat Pump




Air source





Ground source or ground water


(geothermal)




Dual source (combination of air



source and geothermal)




Water loop

Go to Box 15


Box 15. Ventilation and Distribution Equipment for Heating and Cooling


Indicate all that apply:

B—heating and cooling

H—heating only

C—cooling only



Central air handling unit(s) with


constant air volume (CAV) control




Central air handling unit(s) with


variable air volume (VAV) control




Underfloor air distribution




Dedicated outside air system


(DOAS)




Demand controlled ventilation




No mechanical ventilation


equipment


Does the building use either or both of the following?



Air-side economizer




Water-side economizer


Box 16. Water Heating Energy Sources


Which energy sources, if any, were used for water heating during 2012?



Electricity




Natural Gas




Fuel Oil/Diesel/Kerosene




Bottled Gas/LPG/Propane




District Steam




Other (specify)






Box 17. Cooking Energy Sources



Which energy sources, if any, were used for cooking during 2012?



Electricity




Natural Gas




Fuel Oil/Diesel/Kerosene




Bottled Gas/LPG/Propane




District Steam




Other (specify)





: heating only;erng to 00000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000

Box 18. Sources for On-Site Electricity Generation


Which energy sources, if any, were used for on-site electricity generation during 2012?


Check all that apply:



Natural Gas




Fuel Oil/Diesel/Kerosene




Bottled Gas/LPG/Propane




Wood




Coal




Solar




Other (specify)






Box 19. Areas for Food Preparation or Service
(for non-food service buildings only)


Check all of the types of food preparation or serving areas found in the building:




Square feet


Snack bar or



concession stand






Fast food or small



restaurant






Cafeteria or large



restaurant






Large kitchen,



commercial kitchen, or



other large food



food preparation area






Small residential-type



kitchen area






Other (specify)










Box 20. Refrigeration Equipment


Check all the types of refrigeration or freezer equipment that apply and indicate the number used in the building in 2012:




Number


Full-size residential type






Half-size or compact






Walk-in






Open cases or cabinets






Closed cases or cabinets






Refrigerated vending






Commercial ice makers







Percent of



floor area


Large cold storage areas










Go to Box 21



Box 21. Office and Other Equipment


Check all that apply and indicate number used in the building during 2012:





Number


Computers






Laptop computers






Dedicated servers






Printers






Photocopiers






TV or video displays






Cash registers



Box 22. Lighting Equipment


Was any of the square footage in this building lit by the following during 2012?


Check all that apply:



Fluorescent lighting other than compact fluorescent light bulbs





Compact fluorescent bulbs




Incandescent bulbs, other than halogen bulbs





Halogen bulbs




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






Light-emitting diode (LED) lights




Other (specify)






Box. 23. Lighting Controls or Lighting Control Strategies


Check all types of lighting controls or lighting control strategies that were used in the building:



Scheduling (use of time clocks to


turn off or dim lighting)




Occupancy sensors




Multi-level lighting or dimming




Daylight harvesting




High-end trimming or


light-level tuning




Personal light control




Plug-load control




Demand response lighting






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