EIA-871G Characteristics, Energy Sources, and Equipment

CIPSEA Confidentiality Pledge Revision

Worksheet 1 building 2012 871G

CBECS (Voluntary) (OMB 1905-0145)

OMB: 1905-0211

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Worksheet #1:

Characteristics, Energy Sources, and Equipment (Buildings)



2012 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. Completing this worksheet and having it 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

Shape1




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


Year of Construction of Building

Shape2



(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

Shape3




Number of Employees

Shape4



(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, customers, patients, students, or institutionalized residents.)

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 central units




Boilers inside (or directly adjacent


to) 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)



Factory-assembled unitary 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 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




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 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

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 (or directly


adjacent to) 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)




Factory-assembled 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




Check if absorption chiller


can operate as a “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


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


Check all that apply:



Heat Pump System




Packaged unit




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




None of these types




Does the building use either 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




District Hot Water




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




District Hot Water




Other (specify)





: heating only;erng to

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

Check all of the types of food preparation or serving areas found in the building and indicate their total square footage (include seating areas in square footage, if any):




Square feet


Snack bar or



concession stand






Fast food or small



restaurant






Cafeteria or large



restaurant






Large kitchen,



commercial kitchen, or



other large food



preparation area






Small 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 (desktop)






Laptop computers






Printers






Dedicated servers






TV or video displays






Cash registers






Photocopiers



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




Plug-load control




Demand responsive lighting




None of these






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