1. School District ____________________

2. School name ____________________

3. Street ____________________

4. City ____________________

5. Zip Code ____________________

6. Telephone ____________________

7. Principal ____________________

8. Maintenance Coordinator ____________________

9. Year originally built? ____________________

10. Major additions? (yr.) ____________________

Note: We are aware that some items, such as number of portable classrooms, may change frequently.

1. School type:

a. Elementary
b. Middle/Jr. High
c. High School
d. Vocational
e. Community College

2. a. Gross floor area of all premanent buildings? ____________________

b. Conditioned floor area of all permanent buildings? ____________________
(excluding portable classrooms)

3. Number of operated portable classrooms?____________________

a. Total floor area of portable classrooms? ____________________

4. Gymnasium? Yes No

5. Auditoriums? Yes No

6. Media Centers? Yes No

7. Cafeteria? Yes No

a. If Yes, approximately how many meals are prepared on the average school day?___________

b. How many meals are served? ____________________

c. Is this a satellite serving facility ; or a main cooking facility .

8. Number of refrigerators or freezers? ____________________

9. Approximate number of students (maximum) during year? ____________________

10. Average number of faculty/teachers? ____________________

11. Number of administrative/clerical and other staff?____________________

12. Athletic facilities with showers? Yes No

13. Swimming pool? Yes No

a. Heated? Yes No

1. Number of days per year with students? ____________________

2. Year round school? Yes No

3. Closed summers? Yes No

4. Special summer school? Yes No

a. Average number of students? ____________________

5. Number of non-school days with faculty?

6. Night school or adult education? Yes No

7. Schedule during school year: Time (NA if not applicable)

a. Maintenance staff arrives ____________________
b. Faculty/staff arrives ____________________
c. Students arrive ____________________
d. Students depart ____________________
e. Faculty departs ____________________
f. Night school staff arrives ____________________
g. Night students arrive ____________________
h. Night school students depart ____________________
i. Night school staff departs ____________________
j. Maintenance staff departs ____________________

8. Are administrative offices open year round? Yes No

a. If no, what dates so they open ____________________
close ____________________
b. Time open ____________________
c. Time closed ____________________

9. Is the school air conditioned during non-school hours? Yes No

a. During non-school days? Yes No
b. Over summer break and on holidays? Yes No

10. If the school is air conditioned during non-school periods, which of the following are conditioned during these times. (Check all that apply):

a. Most of buildings and facilities
b. Library/media center
c. Gymnasium
d. Administrative offices
e. Cafeteria
f. Other

11. What is the most common cooling temperature maintained inside classroom facilities? (Important! please verify by measurement if possible)

a. In use ____________________
b. Non-occupied periods ____________________

12. What is the most common heating temperature maintained inside facilities?

a. In use ____________________
b. Non-occupied periods ____________________

13. How are interior temperatures maintained (check all that apply):

a. Individual manual thermostats
b. Central thermostats
c. Locked? Yes No
d. Clock thermostats
e. Energy management system
f. Direct Digital Controls (DDC) Yes No Not sure

14. Are windows ever opened for natural ventilation rather than using mechanical cooling? Yes No

15. What is the design mechanical ventilation rate per student (cfm)? ____________________
Don't know____________________

16. Approximately how old is the main HVAC system? ____________________yrs.

17. Previous problems at your facility with excessive humidity (eg. mold/mildew)?

Yes No

18. Have there ever been complaints of poor indoor air quality?

Yes No

19. Previous complaints from students and staff regarding indoor temperatures?

Yes No

20. Have thermostat settings been changed in the last year due to comfort complaints? Yes
No

21. Is an active energy educational awareness program in place?

a. At your school? Yes No
b. At your district? Yes No

(In this section, the facility manager will be asked about a number of technical items, many with which they may be unfamiliar. Please check all that apply and leave blank if unsure. Don't worry if there are questions no one can answer. Do the best you can, but realize that you are not expected to be familiar with all the described systems. Where there are multiple buildings, please check all that apply or give information that is most generally applicable.)

Building

1. Insulated roof or ceiling:

2. Gravel over built up roof

3. Single ply membrane

4. Color: (Light , Medium , Dark )

5. Modified bitumen (tar paper)

6. Asphalt shingle

7. Insulated walls

8. Windows in classrooms

9. No windows in classrooms

10. Tinted or solar control glass

11. Skylights

HVAC

12. Central chillers:

Reciprocating , Screw , Centrifugal , Yes, but don't know type

13. Packaged or split system ACs

14. Roof-top units

15. Heat pumps

16. Water loop heat pumps

17. Window or wall air conditioning units

18. Strip electric resistance heating

19. Heat pump heating

20. Furnace heating system

21. Boiler heating system

22. Cooling tower(s)

23. Variable frequency drives

24. Constant volume air distribution

25. Variable air volume system

26. Fan coil system

27. Ceiling return plenum

28. Dehumidification heat pipes

29. Enthalpy wheel

30. Demand ventilation control (CO₂ sensors)

31. Gas absorption cooling

32. Low temperature air system

Lighting

33. Standard fluorescent lighting fixtures

34. Fluorescent fixtures with electronic ballasts

35. Clock or other automatic scheduling

36. Incandescent exit lighting

37. Fluorescent exit lighting

38. Occupancy sensors

39. Outdoor security lighting

40. Motion sensor control of outdoor lighting

41. Parking lot lighting

42. Athletic field lighting

Controls

43. Fully manual controls

44. Clock controls

45. Operating clock control? Yes No

46. Energy management system (EMS)

47. Operating EMS? Yes No

Miscellaneous

49. Ceiling fans in classrooms? Yes No

50. Computer labs? Yes No

1. What is the primary heating fuel for the facility?

a. Electric

b. Natural gas

c. Oil

d. Propane

e. Solar

2. What is the primary water heating fuel?

a. None, no hot water

b. Electric

c. Natural gas

d. Oil

e. Propane

f. Solar w/backup

F. Very Important! Please attach all utility billing records for each month of 1995 for all fuels that apply:

1 Electricity

2 Natural gas

3 Oil

4 Propane

Primary person completing this survey:

Name: ____________________

Title: ____________________

Telephone: ___________________

Other Comments: __________________________________________________________

________________________________________________________________________

________________________________________________________________________