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Survey Form

WWW.LEDLIGHTINGMANAGEMENT.COM

Basic Information

First Name:

Last Name:

Company Name:

Email:

City:

REFERRED BY:

Building / Property Information

Square Footage of Building : sq.ft.

Age of Building:

Levels / Stories:

Air Conditioning?:

Yes

No

Energy Efficiency Auditing

Has your facility been evaluated for Lighting Efficiency?:

Yes

No

Has your facility been evaluated for Insualtion, Door and Window Efficiency?:

Yes

No

Has your facility been evaluated for HVAC Efficiency?:

Yes

No

HVAC = Heating Ventilation and Air Conditioning

Has your facility been evaluated for Solar, Wind or Geothermal enrgy production?:

Yes

No

Are you aware of the differences between a a building survey and an Investment Grade Audit?:

Yes

No

Do you want to be contacted for any of the above Efficiency or Energy Audits?:

Yes

No

Survey Questions

Does your company use a lot of florescent lighting? :

Yes

No

Does your company use Highbay Fixtures?:

Yes

No

Does your company use Street Lighting?:

Yes

No

Does your company use Parking Lot Lighting?:

Yes

No

Does your company use Flood Lights?:

Yes

No

Approximate Count:

Exact Count:

Does your company have special lighting requirements?:

Yes

No

Special Lighting Requirements:

Energy Efficiency Awareness

Are you informed on LED Lighting energy savings?:

Yes

No

Is there a policy or commitment to energy efficiency?:

Yes

No

Is Net-Zero a stated policy or goal?:

Yes

No

In general, a net-zero energy building produces as much energy as it uses over the course of a year. Net-zero energy buildings are very energy efficient.

Incentive and Rebate Awareness

Are you aware of the Federal tax incentives for LED Lighting?:

Yes

No

Are you aware of the State tax incentives for LED Lighting?:

Yes

No

Are you aware they might be going away in 2013?:

Yes

No

Are you aware of the rebates and incentives from the power company?:

Yes

No

LED Lighting Benefits

Are you informed of the Health bennefits of LED Lighting:

Yes

No

Are you informed of the Light Quality improvements from LED Lighting?:

Yes

No

Are you informed of the lower maintenance costs of LED Lighting?:

Yes

No

Are you informed of the lower Air Conditioning costs due to LED Lighting?:

Yes

No

Are you informed of the Enviromental Benefits of LED Lighting?:

Yes

No

Product and Services Procurement

Where are purchase decisions made at?:

Local Office

Regional Level

Head Office

Are there any specific vendor requirements?:

Yes

No

Specific Vendor Requirements:

Is there a bid process?:

Yes

No

Explanation of Bid Process:

Is a Bid Package currently available?:

Yes

No

When in the future is a Bid Package expected to be made available?:

1 Month

2 Month

3 Month

6 Month

12 Month

18 Month

Who manages the Bid Process?:

Company Management

Engineering Firm

General Contractor

Other

Will upgrades need to be included in the Annual Budget?:

Yes

No

What year are upgrades expected to be budgeted for?:

2012

2013

2014

Copyright © 2012 - LED Lighting Management LLC - All rights reserved

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