DOE F 540.19 Annual Better Plants Program Pledge Form

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Overview

Instructions
Annual Form

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Sheet 1: Instructions

OMB Control No. 1910-5141

Exp. Date 10/31/2022

DOE F 540.19

Reporting Form Field

Instructions

Company Name:

Provide the name of the organization that has committed to the Better Plants Challenge

Company Contact Name:

Provide the name of the person within the organization who is responsible for and knowledgeable of this information.

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 for the plants that are under the scope of the Challenge. 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.

Base Year:

Identify the base year for your pledge agreement, in YYYY format.

Number of Participating Plants:

Identify the number of plants that are represented in your baseline year and current pledge year.

Primary Energy Consumed (MMBtu):

Provide the primary energy (also known as source energy) consumed, by fuel type for the baseline and current years. Exclude energy used as a feedstock. Primary energy is the raw fuel (e.g. natural gas or fuel oil) that is burned to create heat and electricity used in onsite and offsite generation. For additional information, please refer to DOE's Energy Baseline Guidance Document.

Total Primary Energy Consumed (MMBtu):

This number is calculated by the spreadsheet. It represents the total primary energy consumed by the pledge entity, for the current reporting year.

Weather/Production/Other Normalizing related Adjustment for Baseline Primary Energy, (+/- MMBtu):

Identify the baseline adjustment due to weather, production and other normalizing related fluctuations required to estimate energy savings for energy-saving actions taken since the baseline year, if applicable.

Baseline Adjustment Due to Increase/Decrease in the Number of Facilities Reporting Relative to Baseline Year or Other Operational Changes, (+/- MMBtu):

Identify the baseline adjustment due to Increase/Decrease in the Number of Facilities Reporting Relative to Baseline Year or Other Operational Changes, if applicable.

Adjusted Baseline of Primary Energy (MMBtu):

This number is calculated by the spreadsheet using the following equation: Total Primary Energy Use in Baseline Year + Weather/Production/Other Normalizing related Adjustments to Baseline + Baseline Adjustment Due to Increase/Decrease in the Number of Facilities Reporting.

New Energy Savings for Current Year (MMBtu):

This number represents an estimate of the energy savings accumulated since the previous reporting year. This number is calculated using the following equation: New energy savings in current year = (Total energy savings current year – Total energy savings previous year).

Total Energy Savings since Baseline Year (MMBtu):

This number is calculated by the spreadsheet using the following equation: Total Primary Energy Use in Baseline Year + (Weather/Production/Other Normalizing related Adjustments to Baseline + Baseline Adjustment Due to Increase/Decrease in the Number of Facilities Reporting) - Total Primary Energy Use in Current Year = Energy Savings in Current Year. It represents an estimate of the energy savings since the baseline year.

Annual Change In Energy Intensity for Current Year (%):

Provide the change in energy intensity experienced in current year. This number is calculated using the following equation: Annual Change in Energy Intensity for Current Year (%) = Total Change in Energy Intensity for Current Year (%) - Total Change in Energy Intensity for Previous Year (%).

Total Change In Energy Intensity (%):

Provide the total change in energy intensity since the baseline year.

Please describe any methods undertaken to normalize energy intensity data or adjust baseline data to account for economic and other factors that affect energy use:

Briefly describe the rationale behind your adjustment to the baseline for the pledge entity. Reasons might include plant addition or removal from pledge program, weather interactions, increases in production. For additional information, please refer to DOE's Energy Baseline Guidance Document.

Please describe the energy efficient technologies, strategies, and practices employed during the previous year to decrease intensity. Please identify systems impacted and approximate savings from projects. (Ex: Furnace insulation project-12,000 MMBtu/yr savings, compressor controls upgrade-6,000 MMBtu/yr, energy awareness campaign, etc):

Briefly describe, in general, the range of technologies, strategies and practices employed during the current year that resulted in a reduction in energy-intensity. Identify systems and if possible, plants that were impacted. Optional details: approximate energy savings (in $ or Btu), type of fuel, geographic location, industry, and additional descriptive details about the projects.

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

Please mark down the number of plants that have achieved the level of "Energy Intensity Performance Level" indicated in the left hand column of the table. Plant-level energy intensity should be measured on a cumulative basis against the company's baseline year.

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Sheet 2: Annual Form

Company Name:

Company Contact Name:

Address:

Phone:

E-mail Address:

NAICs of Partipating Plants:

Year of reported data:

Base Year:

Baseline Year

Current Year

Number of Participating Plants*:

Primary Energy Consumed (MMBtu):

Baseline Year

Current Year

Electricity

Natural gas

Distillate or Light Fuel Oil (#1, 2, & 4)

Residual or Heavy Fuel Oil (# 5, 6, Navy Special & Bunker C)

Coal

Coke

Blast Furnace Gas

Wood Waste

Other Gas (please specify)

Other Liquid (please specify)

Other Solid (please specify)

Total Primary Energy Consumed, (MMBtu):

0

0

Weather/Production/Other Normalizing related Adjustment for Baseline Primary Energy, (+/- MMBtu):

Baseline Adjustment Due to Increase/Decrease in the Number of Facilities Reporting Relative to Baseline Year or Other Operational Changes, (+/- MMBtu):

Adjusted Baseline of Primary Energy (MMBtu):

0

New Energy Savings for Current Year (MMBtu):

Total Energy Savings since Baseline Year (MMBtu):

0

Annual Change In Energy Intensity for Current Year (%)**:

Total Change in Energy Intensity from Baseline Year (%)**:

*Participating plants should only include those located in the United States

**Please refer to the DOE’s Energy Baseline Guidance document to determine changes in intensity. Improvement in performance should be reported as a positive number.

Please describe any methods undertaken to normalize energy intensity data or adjust baseline data to account for economic and other factors that affect energy use:

Please describe the energy efficient technologies, strategies, and practices employed during the previous year to decrease intensity. Please identify systems impacted and approximate savings from projects. (Ex: Furnace insulation project-12,000 MMBtu/yr savings, compressor controls upgrade-6,000 MMBtu/yr, energy awareness campaign, etc):

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

Please indicate the number of participating plants that achieved the corresponding cumulative improvement levels since baseline year.

Energy Intensity

Number of Plants

Performance Level

<0%

0-2%

2-4%

4-6%

6-8%

8-10%

10-15%

15-20%

20-25%

25-30%

30-35%

>35%

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 3.5 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.