Better Buildings, Better Plants Voluntary Pledge Program

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Overview

Instructions
Baseline Form

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Sheet 1: Instructions

Company Name:

Provide the name of the organization that has committed to the Water Savings Pilot

Company Contact Name:

Provide the name of the person at the organization who is responsible and knowledgeable for the information reported on this form.

Company Contact Title:

Provide the title of the person named as the Company Contact

Address:

Provide the address for the organizational contact.

Phone:

Provide the phone number for the organizational contact.

E-mail Address:

Provide the email address for the organizational contact.

NAICs of Participating Plants:

Provide the 6-digit North American Industry Classification Codes (NAICs) for the facilities that are under the scope of the pledge effort. If more than 1 NAICS code describes the facilities, please provide up to 3. To find your NAICs code, please visit: http://www.naics.com/search.htm

Year of Reported Data:

Identify the current reporting year, in YYYY format.

Baseline Year:

Identify the start and end month/yr of the baseline year for your pledge agreement. Please use MM/YYYY format. For the Baseline Reporting Form, the baseline year identified here should correspond to the Year of Reported Data.

Number of Participating Facilities:

Identify the number of facilities that are represented in the organization's baseline year and current pledge year.

Number of participating facilities that are manufacturing plants

Of the Number of Participating Facilities, indicate the number that are manufacturing plants.

Water intake (thousand gallons):

Provide the water intake in thousands of gallons by water source for the baseline year. Indicate if the intake for each source is determined through metering or estimatation techniques. Also indicate if reduction in the water intake from this source is included in the organization's water reduction target for the Water Savings Pilot. Definitions of each category are (note: Per EPA secondary drinking water standard, 'freshwater' is water containing less than 500 milligrams per liter of total dissolved solids): Water utility (public or private): Freshwater purchased from a local water department Surface freshwater, including self-supplied: Freshwater that collects on the surface of the ground. Surface freshwater sources include water in rivers, streams, creeks, lakes, and reservoirs Ground freshwater, including self-supplied: Freshwater beneath the earth's surface Other freshwater: Freshwater sources not listed Total saline water intake (e.g., ocean water): Total all water intake from sources located outside of the facility with greater than 500 milligrams/liter of dissolved solids. Salt water, such as sea/ocean water, intake would be included here. Rainwater: Rainfall water captured and used onsite Externally supplied recycled: Also referred to as reclaimed water, water from an external source that has been used for elsewhere, treated as required, and supplied to the facility for use. This excludes water recycled on-site and re-used at the facility. Examples include purchased municipality grey water or water used by an adjacent business. Total water intake: Total all the water intake for the facilities included in the Water Pilot. This should be the sum of the preceeding rows

Total water intake included in target (thousand gallons):

Sum the water sources covered under the scope of your water savings commitment. This will serve as your baseline water consumption for the purposes of the program (DOE does not require rainwater or on-site recycled water to be included in this total)

Baseline adjustment due to increase/decrease in the number of facilities reporting relative to baseline year or other operational changes, (+/- thousand gallons):

Identify the baseline adjustment due to Increase/Decrease in the Number of Facilities Reporting Relative to Baseline Year or other operational changes, if applicable. This is only required for current year reporting and not required for baseline year reporting.

If a baseline adjustment was made, please indicate the reason for making the adjustment

Reasons can include changes to the plant portfolio (e.g., acquisitions or closures), significant process changes that impact water consumption (e.g., new product line), or other operational changes since the baseline year that impact water consumption

Unit(s) for water intensity metric

Indicate the unit(s) for the water intensity metric(s) used for tracking water reduction for the Water Savings Pilot. Examples include thousand gallons/ton of product, thousand gallons/labor hours. If using an absolute metric, please indicate the unit of intake being used (e.g., thousand gallons). If using a regression-based approach, leave this field blank.

For partners using a single water intensity metric across all plants, water intensity or other metric used for tracking Water Savings Pilot goal (numeric value)

Indicate the water intensity at the organization level (if one exists) for the baseline year. This is the water intensity against which progress towards target achievement is calculated. If water intensity improvements are calculated at the plant level and rolled up to the organization level, leave this field blank.

Annual improvement in water intensity for current year (%):

Provide the change in water intensity experienced in current year. A simple way of calculating this value is to subtract last year's Total Change in Water Intensity from the current year's Total Change in Water Intensity.

Total change In water intensity (%):

Provide the total change in water intensity since the baseline year. This value can be calculated with the following equation: Total Improvement in Water Intensity (%) = (Water IntensityBaseline Year -- Water IntensityCurrent Year) / Water IntensityBaseline Year

Please describe the methdology used for calculating water intensity improvements:

Briefly describe the data and calculations to determine the reported water intensity improvement, especially the process through which facility-level metrics are rolled up to the corporate level

Please briefly describe the technologies, strategies, and practices employed during the previous year to decrease water intensity. Please identify: systems/processes impacted, approximate water savings from projects, and implementation cost

Briefly describe, in general, the range of technologies, strategies and practices employed since the baseline year that resulted in a reduction in water intensity. If possible, identify systems and/or facilities that were impacted, approximate water savings, and implementation cost . Optional details: geographic location, industry, and additional descriptive details about the projects.

Facility-Level Water Performance (Applies to Companies with Multiple Plants)

Please mark down the number of facilities that have achieved the level of "Water Intensity Performance Level" indicated in the left hand column of the table. Facility-level water intensity should be measured on a cumulative basis against the organization's baseline year.

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Sheet 2: Baseline Form

Company Name:

Company Contact Name:

Company Contact Title:

Address:

Phone:

E-mail Address:

NAICs of Partipating Facilities (max 3):

Year of reported data:

Baseline Year:

Baseline year

Current year

Number of participating facilities*:

Number of participating facilities that are manufacturing plants

Water intake (thousand gallons):

Baseline year

Metered or estimated?

Reporting year

Metered or estimated?

Included in water intensity metric for tracking (y/n)?

Water utility (public or private)

Surface freshwater, including self-supplied

Ground freshwater, including self-supplied

Other freshwater

Total saline water intake (e.g., ocean water)

Rainwater

Externally supplied recycled (i.e., grey water)

Total water intake

Total water intake included in target (thousand gallons)

Baseline adjustment due to increase/decrease in the number of facilities reporting relative to baseline year or other operational changes, (+/- thousand gallons):

If a baseline adjustment was made, please indicate the reason for making the adjustment

Adjusted baseline for total water intake (thousand gallons):

Unit(s) for water intensity metric

Baseline year

Current year

For partners using a single water intensity metric across all plants, water intensity or other metric used for tracking Water Savings Pilot goal (numeric value)

Annual improvement (%) in water intensity for current year

Total improvement (%) in water intensity

Please describe the methdology used for calculating water intensity improvements:

Please briefly describe major technologies, strategies, and practices employed during the previous year to decrease water intensity. Please identify: systems/processes impacted, approximate water savings from projects, and implementation cost

Facility-level Water Performance (Applies to Companies with Multiple Plants)

Please indicate the number of participating facilities that achieved the corresponding total improvement levels since baseline year

Water Intensity

Number of Facilities

Performance (Improvement) Level

<0%

0-2%

2-4%

4-6%

6-8%

8-10%

10-15%

15-20%

20-25%

25-30%

30-35%

>35%

*Participating facilities should be only those located in the United States

This data is being collected to support the Department of Energy Better Buildings Initiative. The data you supply will be used for developing best practices to facilitate reductions in energy intensity by commercial, manufacturing, and community organizations. Public reporting burden for this collection of information is estimated to average 1 hour 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, Enterprise Policy Development & Implementation Office, IM-22, Paperwork Reduction Project (1910-5141), 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 (1910-5141), Washington, DC 20503. Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number. Submission of this data is voluntary.