| Superior Energy PerformanceTM Voluntary Cost/Benefit Form 1 | ||||
| OMB Control #: 1910-NEW. Form no. DOE HQ F 413.3 | ||||
| Exp. Date: XX/XX/XXXX | ||||
| Instructions: These forms are voluntary and your responses will have no impact on your facility's SEP/ISO 50001 certifcation. Please fill out either Form 1, Form 2, or Form 3 based on your facility's ISO 50001/SEP certification status. To identify which form to complete: Form 1: Complete if this is a first certification to both ISO 50001 and SEP for your facility Form 2: Complete if this is a recertification to ISO 50001 and first SEP certification for your facility OR if this is an upgrade to SEP mid-ISO 50001 certification Form 3: Complete if this is a recertification to both ISO 50001 and SEP for your facility All facilities are asked to fill out Form 4. |
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| First ISO 50001 and SEP certification implementation cost details | ||||
| Timeline for ISO 50001 EnMS implementation | Guidance | |||
| 1 | When did this facility initiate its implementation of an ISO 50001 EnMS (month/yr)? | Please indicate when this facility initiated its ISO 50001 implementation. Initiatation date is determined at the facility's discretion but some examples of initiation dates include date of first training or assembly of energy management team | ||
| 2 | What was the time period required to implement the ISO 50001 EnMS (months) | Please indicate how many months transpired between the ISO 50001 EnMS implementation initiation date indicated in question 1 and the date of the initial top management review. The period between these two events is considered the period to implement the ISO 50001 EnMS. | ||
| ISO 50001 EnMS and SEP implementation | ||||
| Internal Staff Costs | Guidance | |||
| Questions 3 - 10 are designed to identify the additional staff effort required, beyond existing energy related activities, to implement the ISO 50001 EnMS and prepare for the SEP certification audit. | ||||
| 3 | Number of people that served on the energy management team prior to implementation of the ISO 50001 EnMS | Please indicate the number of people (all people including full time, part time, on staff, or contractors) that were part of the facility's energy management team prior to the date listed in question 1 | ||
| 4 | Typical annual level of effort by energy management team prior to implementation of the ISO 50001 EnMS expressed as full time employee (FTE) positions (1 FTE = 1.0) | Summation of effort for all members of the energy management team identified in question 3 in terms of full-time employees (FTE). For example, if the energy management team consisted of 1 member spending 100% of their effort fulfilling their responsibilities for the energy management team, then the total FTE would be 1.0 (1 member at 1 FTE) |
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| 5 | Please indicate the annual cost in dollars associated with the typical annual effort identified in question 4 ($/yr) | If the annual effort identified in question 4 is 1.0 FTE and the compensation rate is $100,000/yr (wages plus overhead) per FTE, then the annual cost associated with the typical annual effort is $100,000. | ||
| 6 | Number of people that serve on the energy management team during implementation of the ISO 50001 EnMS | Please indicate the number of people (all people including full time, part time, on staff, or contractors) that were part of the facility's energy management team while implementing the ISO 50001 EnMS (the period listed in question 2). | ||
| 7 | Typical annual level of effort by energy management team during implementation of the ISO 50001 EnMS expressed as full time employee (FTE) positions (1 FTE = 1.0) | Summation of effort for all members of the energy management team identified in question 6 in terms of full-time employees (FTE). For example, a facility had 1 employee with 100% of their job responsibilities related to facility energy issues prior to beginning its ISO 50001/SEP EnMS implementation. When the facility decides to implement ISO 50001/SEP, it brings on additional employees to assist with implementation and certification as follows: • 1 internally recruited employee from the facilities division for 12 months with 50% of their responsibilities involving ISO 50001/SEP implementation (0.5 FTE) • 1 contracted employee for 12 months with 50% of their responsibilities involving ISO 50001/SEP implementation (0.5 FTE) • 1 internally recruited employee who had assisted in the facility's ISO 14001 audit preparation for 6 months with 100% of their responsibilities related to ISO 50001/SEP audit preparation (0.5 FTE) The staff effort of the energy management team during implementation ISO 50001/SEP would be 2.5 FTE (1 member at 1 FTE from existing activities + 3 members at 0.5 FTE each recruited for ISO 50001/SEP = 2.5 FTE). |
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| 8 | Please indicate the annual cost in dollars associated with the typical annual effort identified in question 7 ($/yr) | The annual effort identified in question 7 is 2.5 FTE. If the compensation rate is $100,000/yr (wages plus overhead) per FTE, then the annual cost associated with the typical annual effort is $250,000. | ||
| 9 | The additional staff effort required, beyond existing energy related activities, to implement the ISO 50001 EnMS and prepare for the SEP certification audit is (FTE): | 0 | This cell is autocompleted. It is calculated by taking the difference between the responses in questions 7 and 4. If the autocompleted value does not align with any independent evaluation conducted by the facility to assess the additional staff effort to implement the ISO 50001 EnMS and prepare for the SEP certification audit, please adjust your responses to questions 4 and 7. | |
| 9a | Please indicate the percent of this additional staff effort (question 9) that was outsourced (%)? | Of the additional staff effort calculated in question 9, please indicate the % outsourced. For example, in the guidance for question 7, 1 of the employees spending 12 months with 50% of their responsibilities devoted to ISO 50001 implemenation and SEP audit preparation activities was a contractor. If the total additional effort was 1.5 FTE (from question 9), the % of the additional effort that was outsourced is 33% (0.5 FTE/1.5 FTE x 100= 33%) | ||
| 10 | The additional staff cost required, beyond existing energy related activities, to implement the ISO 50001 EnMS and prepare for the SEP certification audit is ($): | 0 | This cell is autocompleted. It is calculated by taking the difference between the responses in questions 8 and 5. If the autocompleted value does not align with any independent evaluation conducted by the facility to assess the additional staff cost to implement the ISO 50001 EnMS and prepare for the SEP certification audit, please adjust your responses to questions 5 and 8. | |
| 11 | Please estimate the future annual effort to maintain the SEP conformant ISO 50001 EnMS (FTE) | Please indicate the future internal staff effort per year the facility is planing on allocating to maintain their SEP conformant ISO 50001 EnMS | ||
| External Costs | Guidance | |||
| Technical assistance costs during the achievement period for: | For current certification: | |||
| 12 | ISO 50001 EnMS implementation ($) | Please indicate any costs incurred by the facility for hiring outside technical assistance to assist for ISO 50001 EnMS implementation. Only consider costs for technical assistance hired for less than 12 consecutive months. | ||
| 13 | Energy assessment(s) ($) | Please indicate any costs incurred by the facility for hiring outside experts to conduct energy assessments of energy consuming systems | ||
| 14 | ISO 50001/SEP certification audit preparation ($) | Please indicate any costs incurred by the facility for hiring outside experts to assist with ISO 50001/SEP certification audit preparation. Only consider costs for outside expert(s) hired for less than 12 consecutive months. | ||
| 15 | Costs of metering installed to meet SEP certification requirements ($) | Please indicate any costs incurred by the facility for purchasing and installing meters to meet SEP certification requirements (i.e., monitoring significant energy uses, determining energy performance improvements, etc) | ||
| 16 | Costs of 3rd party ISO 50001/SEP certification audits ($) | Please indicate the costs incurred by the facility for all SEP/ISO 50001 audits (including surveillance, certification) paid to the auditor | ||
| 17 | Was subsidized assistance provided for implementation of the SEP conformant EnMS? (y/n) | Please indicate if any outside assistantce (i.e., financial, consulting) was provided to assist with implementation of the SEP conformant EnMS | ||
| 18 | If yes to the previous question, what was the source of this assistance? | Please list the source of outside assistance. Examples of sources include utility or energy efficiency rebate program, state of local government assistance, or federal government assistance | ||
| Certification status of parent company owned facilities | Guidance | |||
| Are other facilities (U.S. and non-U.S.) owned by the parent company (if applicable): | If this facility is owned by a parent company, please indicate if other facilities owned by the parent company are either ISO 50001 or SEP certified: | |||
| 19 | ISO 50001 certified (yes/no)? | |||
| 20 | SEP certified (yes/no)? | |||
| Does the parent company require implementation of: | Please indicate if this facility's ISO 50001/SEP certification was part of a requirement set by the parent company | |||
| 21 | ISO 50001 (yes/no) | |||
| 22 | SEP (yes/no) | |||
| Please proceed to SEP Voluntary Cost/Benefit Form 4 | ||||
| Public reporting burden for this collection of information is estimated to average 4 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Records & Privacy Management Division, IM-23, Paperwork Reduction Project (OMB control # 1910-NEW), U.S. Department of Energy, 1000 Independence Ave SW, Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project (OMB control # 1910-NEW), Washington, DC 20503. DOE maintains the confidentiality of proprietary energy and production related data as proprietary that is submitted to the Superior Energy Performance (SEP) program by SEP certified facilities, to the fullest extent of the law. Data included within the SEP Enrollment and Application forms, SEP Energy Performance Improvement Report and SEP Voluntary Cost Benefit Form will not be released publicly. DOE will make public the following information about each SEP certified facility: 1. Facility name 2. Facility location (city, state) 3. Verified Achievement Level (e.g., Silver, Gold, or Platinum) 4. Verified Reporting Period Energy Performance Improvement 5. Certification date (month/year) DOE will, from time-to-time, publicly share aggregate, program-wide metrics, such as number of SEP certified plants, and annual and cumulative SEP program energy savings. All data provided to DOE is subject to the Freedom of Information Act (FOIA), however, DOE will notify partners if a FOIA request has been submitted for which their data might be responsive . DOE will consult with the partner and ensure the partner has an opportunity to inform DOE what data they view is proprietary. DOE will review the partner’s suggestions and will not release to the public any data DOE deems proprietary. |
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| Superior Energy PerformanceTM Voluntary Cost/Benefit Form 2 | ||||
| OMB Control #: 1910-NEW | ||||
| Exp. Date: XX/XX/XXXX | ||||
| Instructions: These forms are voluntary and your responses will have no impact on your facility's SEP/ISO 50001 certifcation. Please fill out either Form 1, Form 2, or Form 3 based on your facility's ISO 50001/SEP certification status. To identify which form to complete: Form 1: Complete if this is a first certification to both ISO 50001 and SEP for your facility Form 2: Complete if this is a recertification to ISO 50001 and first SEP certification for your facility OR if this is an upgrade to SEP mid-ISO 50001 certification Form 3: Complete if this is a recertification to both ISO 50001 and SEP for your facility All facilities are asked to fill out Form 4. |
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| ISO 50001 EnMS recertification and first SEP certification | ||||
| Internal Staff Costs | ||||
| Questions 1 - 8 are designed to identify the additional staff effort required to enhance the facility's existing ISO 50001 EnMS in order to make it SEP compliant. | Guidance | |||
| 1 | Number of people that serve on the energy management team prior to ISO 50001 EnMS enhancements and SEP certification | Please indicate the number of people (all people including full time, part time, on staff, or contractors) that were part of the facility's energy management team, including those required for ISO 50001 EnMS maintenance, prior to enhancing the ISO 50001 EnMS to comply with SEP. | ||
| 2 | Typical annual level of effort by energy management team prior to ISO 50001 enhancements and SEP certification, expressed as full time employee (FTE) positions (1 FTE = 1.0) | Summation of effort for all members of the energy management team identified in question 1 in terms of full-time employees (FTE). For example, if the energy management team consists of 4 members with: • 1 member spending 100% of their effort fulfilling their responsibilities for the energy management team • 3 members spending 50% of their effort fulfilling their responsibilities for the energy management team the total FTE would be 2.5 (1 member at 1 FTE + 3 members at 0.5 FTE = 2.5 FTE) |
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| 3 | Please indicate the annual cost in dollars associated with the typical annual effort identified in question 2 ($/yr) | If the annual effort identified in question 2 is 2.5 FTE and the compensation rate is $100,000/yr (wages plus overhead) per FTE, then the annual cost associated with the typical annual effort is $250,000. | ||
| 4 | Number of people that serve on the energy management team during ISO 50001 EnMS enhancements and SEP certification | Please indicate the number of people (all people including full time, part time, on staff, or contractors) that were part of the facility's energy management team, including those required to maintain and enhance the ISO 50001 EnMS to comply with SEP. | ||
| 5 | Typical annual level of effort by the energy management team during ISO 50001 enhancements and SEP certification, expressed as full time employee (FTE) positions (1 FTE = 1.0) | Summation of effort for all members of the energy management team identified in terms of full-time employees (FTE). For example, a facility had 4 employees with all or part of their job responsibilities related to maintaining the ISO 50001 EnMS on the energy management team totalling 2.5 FTE . The facility decides to pursue SEP for its ISO 50001 recertification. To assist with ISO 50001 recertification/SEP implementation, the facility adds 2 additional team members: • 1 contractor for 12 months at 50% of their time to assist the current energy management team enhance the facility's ISO 50001 EnMS (0.5 FTE) • 1 internally recruited employee for 3 months at 50% of his/her time to assist with audit preparation (0.1 FTE rounded from 0.125 FTE) The estimated staff effort per year is: 2.5 FTE for ISO 50001 EnMS maintenance and 0.6 FTE for the additional effort beyond existing ISO 50001 EnMS maintenance to enhance and certify the facility's ISO 50001 EnMS into SEP conformance. The total staff effort during ISO 50001 enhancements and SEP certification was 3.1 FTE (2.5 FTE + 0.6 FTE). |
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| 6 | Please indicate the annual cost in dollars associated with the typical annual effort identified in question 5 ($/yr) | The annual effort identified in question 5 is 3.1 FTE. If the compensation rate is $100,000/yr (wages plus overhead) per FTE, then the annual cost associated with the typical annual effort is $310,000. | ||
| 7 | The additional staff effort required, beyond ISO 50001 maintenance, to enhance the ISO 50001 EnMS and comply with SEP (FTE): | 0 | This cell is autocompleted. It is calculated by taking the difference between the responses in questions 5 and 2. If the autocompleted value does not align with any independent evaluation conducted by the facility to assess the additional staff effort to implement the ISO 50001 EnMS and prepare for the SEP certification audit, please adjust your responses to questions 2 and 5. | |
| 7a | Of the additional staff effort identified in question 7, what percent of the effort was outsourced (%)? | Of the total additional effort listed in question 7, please indicate the % of this effort fulfilled by contractors. For example, in the energy management team described in the guidance for question 5, since one contractor was brought on for 12 months at 50% effort to assist with ISO 50001 enhancements and SEP certifiction, the % of the additional effort for contractors would be 83% (0.5 FTE / 0.6 FTE x 100= 83%) | ||
| 8 | The additional staff cost required, beyond ISO 50001 maintenance, to enhance the ISO 50001 EnMS and comply with SEP ($): | 0 | This cell is autocompleted. It is calculated by taking the difference between the responses in questions 6 and 3. If the autocompleted value does not align with any independent evaluation conducted by the facility to assess the additional staff cost to implement the ISO 50001 EnMS and prepare for the SEP certification audit, please adjust your responses to questions 3 and 6. | |
| 9 | Please estimate the future annual effort to maintain the SEP conformant ISO 50001 EnMS (FTE) | Please indicate the future internal staff effort per year in FTEs the facility is planing on allocating to maintain their SEP conformant ISO 50001 EnMS | ||
| External Costs | Guidance | |||
| Technical assistance costs during the current achievement period for: | For the current certifification: | |||
| 10 | ISO 50001 EnMS enhancements ($) | Please indicate any costs incurred by the facility for hiring outside technical assistance to assist in ISO 50001 EnMS enhancements. Only consider here technical assistance hired for less than 12 months. | ||
| 11 | Supplemental energy assessment(s) ($) | Please indicate any costs incurred by the facility for hiring outside experts to conduct energy assessments of energy consuming systems (do not include any energy assessments occurring outside of the SEP Achievement Period) | ||
| 12 | ISO 50001/SEP certification audit preparation ($) | Please indicate any costs incurred by the facility for hiring outside experts to assist with ISO 50001/SEP certification audit preparation. Only consider here costs for technical assistance hired for less than 12 months. | ||
| 13 | Costs of metering installed to meet SEP certification requirements ($) | Please indicate any costs incurred by the facility for purchasing and installing meters to meet SEP certification requirements (i.e., monitoring significant energy uses, determining energy performance improvements, etc) | ||
| 14 | Costs of 3rd party ISO 50001/SEP cerification audits ($) | Please indicate the costs incurred by the facility for all SEP/ISO 50001 audits (including surveillance, certification) paid to the auditor for this ISO 50001 recertification/SEP certification | ||
| 15 | Was subsidized assistance provided for implementation of the SEP conformant EnMS? (y/n) | Please indicate if any outside assistantce (i.e., financial, consulting) was provided to assist with implementation of the SEP conformant EnMS | ||
| 16 | If yes to the previous question, what was the source of this assistance? | Please list the source of outside assistance. Examples of sources include utility or energy efficiency rebate program, state of local government assistance, federal government assistance | ||
| Certification status of parent company owned facilities | Guidance | |||
| Are other facilities (U.S. and non-U.S.) owned by the parent company: | If this facility is owned by a parent company, please indicate if other facilities owned by the parent company are either ISO 50001 or SEP certified: | |||
| 17 | ISO 50001 Certified (yes/no)? | |||
| 18 | SEP Certified (yes/no)? | |||
| Does the parent company require implementation of: | Please indicate if this facility's ISO 50001/SEP certification was part of a requirement set by the parent company | |||
| 19 | ISO 50001 (yes/no) | |||
| 20 | SEP (yes/no) | |||
| Please proceed to SEP Voluntary Cost/Benefit Form 4 | ||||
| Public reporting burden for this collection of information is estimated to average 4 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Records & Privacy Management Division, IM-23, Paperwork Reduction Project (enter OMB control number), U.S. Department of Energy, 1000 Independence Ave SW, Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project (enter OMB control number), Washington, DC 20503. DOE maintains the confidentiality of proprietary energy and production related data as proprietary that is submitted to the Superior Energy Performance (SEP) program by SEP certified facilities, to the fullest extent of the law. Data included within the SEP Enrollment and Application forms, SEP Energy Performance Improvement Report and SEP Voluntary Cost Benefit Form will not be released publicly. DOE will make public the following information about each SEP certified facility: 1. Facility name 2. Facility location (city, state) 3. Verified Achievement Level (e.g., Silver, Gold, or Platinum) 4. Verified Reporting Period Energy Performance Improvement 5. Certification date (month/year) DOE will, from time-to-time, publicly share aggregate, program-wide metrics, such as number of SEP certified plants, and annual and cumulative SEP program energy savings. All data provided to DOE is subject to the Freedom of Information Act (FOIA), however, DOE will notify partners if a FOIA request has been submitted for which their data might be responsive . DOE will consult with the partner and ensure the partner has an opportunity to inform DOE what data they view is proprietary. DOE will review the partner’s suggestions and will not release to the public any data DOE deems proprietary. |
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| Superior Energy PerformanceTM Voluntary Cost/Benefit Form 3 | ||||
| OMB Control #: 1910-NEW | ||||
| Exp. Date: XX/XX/XXXX | ||||
| Instructions: These forms are voluntary and your responses will have no impact on your facility's SEP/ISO 50001 certifcation. Please fill out either Form 1, Form 2, or Form 3 based on your facility's ISO 50001/SEP certification status. To identify which form to complete: Form 1: Complete if this is a first certification to both ISO 50001 and SEP for your facility Form 2: Complete if this is a recertification to ISO 50001 and first SEP certification for your facility OR if this is an upgrade to SEP mid-ISO 50001 certification Form 3: Complete if this is a recertification to both ISO 50001 and SEP for your facility All facilities are asked to fill out Form 4. |
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| ISO 50001 and SEP recertification | ||||
| Internal Staff Costs | Guidance | |||
| 1 | Number of people that serve on the energy management team | Please indicate the number of people (all people including full time, part time, on staff, or contractors) that are part of the facility's energy management team | ||
| 2 | Typical annual level of effort by energy management team expressed as full time employee (FTE) positions (1 FTE = 1.0) | Summation of effort for all members of the energy management team identified in question 1 in terms of full-time employees (FTE). For example, if the energy management team consists of 4 members with: • 1 member spending 100% of their effort fulfilling their responsibilities for the energy management team • 3 members spending 50% of their effort fulfilling their responsibilities for the energy management team the total FTE would be 2.5 (1 member at 1 FTE + 3 members at 0.5 FTE = 2.5 FTE) |
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| 2a | Of the annual effort identified in question 2, what percent is outsourced (%)? | Of the total additional effort listed in question 2, please indicate the % of this effort fulfilled by contractors. For example, in the energy management team described in the guidance for question 2, if one of the members representing 0.5 FTE is a contractor, the % of the effort represented by contractors would be 25% (0.5 FTE/2.5 FTE = 25%) | ||
| 3 | Please indicate the annual cost in dollars associated with the typical annual effort identified in question 2 ($/yr) | If the annual effort identified in question 2 is 2.5 FTE and the compensation rate is $100,000/yr (wages plus overhead) per FTE, then the annual cost associated with the typical annual effort is $250,000. | ||
| 4 | Please estimate the future annual effort to maintain the SEP conformant EnMS (FTE) | Please indicate the future internal staff effort the facility is planing on allocating to maintain their SEP conformant EnMS | ||
| External Costs | Guidance | |||
| Technical assistance costs during the current achievement period for: | ||||
| 5 | SEP conformant EnMS maintenance ($) | Please indicate any costs incurred by the facility for hiring outside technical assistance to assist in SEP conformant EnMS maintenance. Only consider here technical assistance hired for less than 12 months. | ||
| 6 | Supplemental energy assessment(s) ($) | Please indicate any costs incurred by the facility for hiring outside experts to conduct energy assessments of energy consuming systems (do not include any energy assessments occurring outside of the SEP Achievement Period) | ||
| 7 | ISO 50001/SEP recertification audit preparation ($) | Please indicate any costs incurred by the facility for hiring outside experts to assist with ISO 50001/SEP certification audit preparation. Only consider here costs for technical assistance hired for less than 12 months. | ||
| 8 | Costs of metering installed to meet SEP certification requirments ($) | Please indicate any costs incurred by the facility for purchasing and installing meters to improve operational control of energy uses, monitor significant energy uses new to this certification, determine energy performance improvements, etc. | ||
| 9 | Costs of 3rd party ISO 50001/SEP recerification audits ($) | Please indicate the costs incurred by the facility for all ISO 50001/SEP audits (including surveillance, certification) paid to the auditor for this ISO 50001/SEP recertification | ||
| Certification status of parent company owned facilities | Guidance | |||
| Are other facilities (U.S. and non-U.S.) owned by parent company: | If this facility is owned by a parent company, please indicate if other facilities owned by the parent company are either ISO 50001 or SEP certified: | |||
| 10 | ISO 50001 Certified (yes/no)? | |||
| 11 | SEP Certified (yes/no)? | |||
| Does company require implementation of: | Please indicate if this facility's ISO 50001/SEP certification was part of a requirement set by the parent company | |||
| 12 | ISO 50001 (yes/no) | |||
| 13 | SEP (yes/no) | |||
| Please proceed to SEP Voluntary Cost/Benefit Form 4 | ||||
| Public reporting burden for this collection of information is estimated to average 4 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Records & Privacy Management Division, IM-23, Paperwork Reduction Project (enter OMB control number), U.S. Department of Energy, 1000 Independence Ave SW, Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project (enter OMB control number), Washington, DC 20503. DOE maintains the confidentiality of proprietary energy and production related data as proprietary that is submitted to the Superior Energy Performance (SEP) program by SEP certified facilities, to the fullest extent of the law. Data included within the SEP Enrollment and Application forms, SEP Energy Performance Improvement Report and SEP Voluntary Cost Benefit Form will not be released publicly. DOE will make public the following information about each SEP certified facility: 1. Facility name 2. Facility location (city, state) 3. Verified Achievement Level (e.g., Silver, Gold, or Platinum) 4. Verified Reporting Period Energy Performance Improvement 5. Certification date (month/year) DOE will, from time-to-time, publicly share aggregate, program-wide metrics, such as number of SEP certified plants, and annual and cumulative SEP program energy savings. All data provided to DOE is subject to the Freedom of Information Act (FOIA), however, DOE will notify partners if a FOIA request has been submitted for which their data might be responsive . DOE will consult with the partner and ensure the partner has an opportunity to inform DOE what data they view is proprietary. DOE will review the partner’s suggestions and will not release to the public any data DOE deems proprietary. |
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| Superior Energy PerformanceTM Voluntary Cost/Benefit Form 4 | |||||||||
| OMB Control #: 1910-NEW | |||||||||
| Exp. Date: XX/XX/XXXX | |||||||||
| Instructions: These forms are voluntary and your responses will have no impact on your facility's SEP/ISO 50001 certifcation. All facilities are asked to fill out this form (Form 4) |
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| Details of the energy performance improvement actions used in the bottom up analysis to verify facility level energy performance improvement (for up to 10 actions) | |||||||||
| Action 1 | Action 2 | … | Action 9 | Action 10 | Guidance | ||||
| 1 | Name and description of energy saving action | A brief (100 word maximum) description of the action (e.g., implemented steam trap maintenance program, raised chiller set point temperature) | |||||||
| 2 | Date of implementation (month/yr) | Date the action was completed | |||||||
| 3 | Did the action require budgeted capital expenditure (yes/no)? | This question seeks to understand if the action required capital appropriations, as opposed to using existing operating/maintenance funds | |||||||
| 4 | What systems were effected (pick from dropdown)? | Select the energy using systems whose energy consumption was impacted by the action. Please choose from: steam/hot water, process heat, process cooling and refrigeration, compressed air, pumping, fans, other motor drives (aside from compressed air, pumps, fans), cogeneration, computing, HVAC, lighting, process specific (e.g., changing raw material input for energy savings, scheduling to reduce energy costs) | |||||||
| 5 | What energy sources were effected (pick from dropdown)? | Select the energy sources that were impacted, either reduced or increased, by the action. Please select from electricity, natural gas, distillate or light fuel oil (#1,2, & 4), residual or heavy oil (#5, 6, Navy Special & Bunker C), coal, coke, blast furnace gas, wood waste, other (specify). Indicate if source increased or decreased. | |||||||
| 6 | Net primary (source) annual energy consumption savings (MMBtu) | Please indicate the net primary (source) annual energy savings resulting from implementation of the action aggregated across all energy sources. Net primary savings will be the sum of all energy consumption savings discounted by any increases in energy consumption from other energy sources (i.e., fuel switching). Some examples of methods for estimating savings include using engineering estimates, meter data, or utility bill data. Please use the site to primary (source) multipliers per section 3.7 of the SEP Measurement and Verification Protocol. | |||||||
| 7 | Net annual energy cost savings ($) | Please indicate the net annual energy cost savings resulting from implementation of the action aggregated across all energy sources. Net primary cost savings will be the sum of all energy cost savings discounted by any increases in energy costs from other energy sources (i.e., fuel switching). Some examples of methods for estimating savings include using engineering estimates, meter data, or utility bill data | |||||||
| 8 | Total implementation cost, excluding any rebates and incentives ($) | Please total all costs associated with implemenation of the action including: engineering staff and external consultant costs, equipment costs, installation costs, environmental compliance costs, equipment removal costs, etc. Do not include any rebates or incentives received to offset the implementation cost. | |||||||
| 9 | Total rebates and incentives provided for this action ($)? | Please total all rebates and incentives received to offset the implementation cost of this action including: utility or government rebates, tax incentives, fee waivers, permit waivers, value of technical assistance provided, etc | |||||||
| Corollary benefits from SEP conformant ISO 50001 EnMS | |||||||||
| Guidance | |||||||||
| Additional benefits from ISO 50001 / SEP implementation and certification | Yes/No | If yes, was it a driver for pursuing ISO 50001 or SEP (yes/no)? | Please specify | This section aims to understand the corollary benefits of implementing SEP. These are benefits beyond energy consumption and energy cost savings. If the answer to any of the following questions is 'yes', please indicate in the adjacent column if this was a desired outcome of ISO 50001/SEP implementation | |||||
| Positive impacts on productivity | |||||||||
| 10 | Throughput | Please indicate if implementing SEP resulted in increased product throughput | |||||||
| 11 | Capacity | Please indicate if implementing SEP led to increased production capacity | |||||||
| 12 | Electric demand savings | Please indicate if implementing SEP contibuted to reduced electric demand | |||||||
| 13 | Waste reduction | Please indicate if implementing SEP contributed to reduced waste | |||||||
| 14 | Water use reduction | Please indicate if implementing SEP resulted in reduced facility water usage | |||||||
| 15 | Enhance community stewardship | Please indicate if implementing SEP has improved (or is expected to improve) the environmental image of the facility within its community | |||||||
| 16 | Increased employee engagement | Please indicate if SEP implementation resulted in increased employee engagement with management initiatives, such as energy conservation efforts | |||||||
| 17 | Other | Please indicate if implementing SEP resulted in any other corollary benefits not addressed by the preceeding questions. Please specify these benefits in column H | |||||||
| Public reporting burden for this collection of information is estimated to average 4 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Records & Privacy Management Division, IM-23, Paperwork Reduction Project (enter OMB control number), U.S. Department of Energy, 1000 Independence Ave SW, Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project (enter OMB control number), Washington, DC 20503. DOE maintains the confidentiality of proprietary energy and production related data as proprietary that is submitted to the Superior Energy Performance (SEP) program by SEP certified facilities, to the fullest extent of the law. Data included within the SEP Enrollment and Application forms, SEP Energy Performance Improvement Report and SEP Voluntary Cost Benefit Form will not be released publicly. DOE will make public the following information about each SEP certified facility: 1. Facility name 2. Facility location (city, state) 3. Verified Achievement Level (e.g., Silver, Gold, or Platinum) 4. Verified Reporting Period Energy Performance Improvement 5. Certification date (month/year) DOE will, from time-to-time, publicly share aggregate, program-wide metrics, such as number of SEP certified plants, and annual and cumulative SEP program energy savings. All data provided to DOE is subject to the Freedom of Information Act (FOIA), however, DOE will notify partners if a FOIA request has been submitted for which their data might be responsive . DOE will consult with the partner and ensure the partner has an opportunity to inform DOE what data they view is proprietary. DOE will review the partner’s suggestions and will not release to the public any data DOE deems proprietary. |
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| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |