Your Name:  Phone:

Congregation:                                                                                                                          
City: Zip Code:

Compact Fluorescent Light (CFL) Bulbs

Number CFLs installed at your facility in 2007:                                                                

Number CFLs installed at your facility total (since 2000):
           
Number sold or distributed through a congregation program:

Energy Audit

Have you done an energy audit on your facility? Yes No                                     

Energy Retrofits (excluding lighting)

What subsequent changes have you made to your building(s) in the past year? (e.g. weather strip windows, seal leaky ducts, lighting sensors, etc.)

Have your facility’s electricity costs been reduced as a result? Yes  No                                     

Was your facility involved in a construction project in 2007? Yes  No

Are you planning any new construction, or a new building in 2008? Yes  No

If yes, are you using LEED or Green Building guidelines in your plans? Yes  No

Exit Signs

Number LED exit signs installed at your facility in 2007:

Number LED exit signs installed at your facility total (since 2000):

Number CFL exit signs installed at your facility in 2007:

Number CFL exit signs installed at your facility total (since 2000):

Solar Panels

Do you have any solar panels on your facility? Yes  No

If yes, what size system (in kw)?

Transportation

Does your congregation own any vehicles for congregational use only? Yes  No

If yes, how many?

Cars:

Vans or trucks:

Other types of vehicles (school buses, etc.?):

Have you replaced any conventional vehicles with hybrid vehicles or alternative fuel vehicles?
Yes  No

If yes, how many? 

What type of vehicle?

In their commute to work, do the congregation’s employees participate in (check all that apply):

ridesharing
carpools or vanpools
use of public transit
bicycling
walking to work

If yes, how many employees participate?

How many do not participate?

Education

Did you give a sermon about global warming or energy issues in 2007? Yes  No

Did your congregation host or sponsor an educational workshop, class, or special program about global warming for your congregation in 2007?
Yes  No

Did you do any community or denominational outreach on energy or global warming in 2007 (clergy meetings, retreats, seminars, workshops)? Yes  No

If yes, what kind of outreach?

Public Policy

Did you send letters or postcards about a global warming issues in 2007? Yes  No

If so, what issue(s)?

Optional Questions:

Green Power

Do you participate in a green power program through your local utility district? Yes  No

If yes, what is your average monthly Kwh (electricity consumption)?

Tree Planting

Did you participate in a tree planting program in 2007? Yes  No

If yes, how many trees were planted in 2007?

Operations

How many hours per week does your facility operate during an average week of the year? (an estimate is fine)?

What is the estimated total square footage of your facility?

Number of members at your congregation:

Number of full-time staff members at your congregation:

Number of part-time staff:

Does your facility have: One building  Multiple buildings

Is your facility involved in the following uses?

School
Day Care
Commercial kitchen
Retail
Other use besides worship and educational uses

Any other comments (ex: cool roofs, other energy efficiency or conservation measures implemented, notable projects, etc.)?