Questionnaire for Quotation Preparation
Please complete the questionnaire and return it to:
TÜV SÜD Management Service GmbH, Ridlerstrasse 65, D – 80339 Munich
By fax to: +49 (0) 89 / 5791 – 2197
EN 16001:2009 EN 50001:2011 / The questionnaire on the General Part is required together with this questionnaire.
Site 1 =
Headquarters (Central Office) / Site 2*)
*) If the organization has more than 2 sites, please use an additional form.
Name of the organization
Address
Business year / Calendar year
BY from to / Calendar year
BY from to
Employees per site (excl. trainees) / Number: / Number:
Of which not working at the site: / Number: / Number:
Of which employees carrying out similar, simple activities (e.g. assembly line, call centres) / Number: / Number:
Of which marginal part-timers
(earning less than
€ 400 per months)
or unskilled temporary workers / Number: / Number:
Of which part-time employees
(including hired staff): / Number:
Hrs./day / Number:
Hrs./day
Of which seasonal staff: / Number: / Number:
Number of shifts: / Number:
Processes identical across all shifts
Processes differ significantly / Number:
Processes identical across all shifts
Processes differ significantly
Employees per shift
/ Number: / Number:
Manufacturing process/manufactur-ing technologies at the site / 1.
2.
3.
4. / 1.
2.
3.
4.
Products /
product groups (site-specific if necessary)
/ 1.
2.
3.
4. / 1.
2.
3.
4.
Site-specific scope of certification
(e.g. design and development, manufacturing and sales of...) or main activity at the site
Total energy consumption
/ Total energy consumption per business year
< 5 million kWh (GWh)
5 million kWh ≤ x ≥ 10 million kWh (GWh)
> 10 million kWh (GWh)
Types of energy:
Electricity
Natural gas
Heating oil
Steam
(District) heating,
Energy from renewable sources (e.g. biogas,…)
Others: / Total energy consumption per business year
< 5 million kWh (GWh)
5 million kWh ≤ x ≥ 10 million kWh (GWh)
> 10 million kWh (GWh)
Types of energy:
Electricity
Natural gas
Heating oil
Steam
(District) heating,
Energy from renewable sources (e.g. biogas,…)
Others:
Reallocation charges under Germany's Renewable Energy Act / Has the organization used the special compensation scheme under Art. 40 et seq. of Germany's Renewable Energy Act (EEG) or will it use this compensation scheme in the future?
Yes
No
Has the organization been certified in accordance with Art. 41 EEG? Please enclose certificate. / Has the organization used the special compensation scheme under Art. 40 et seq. of Germany's Renewable Energy Act (EEG) or will it use this compensation scheme in the future?
Yes
No
Has the organization been certified in accordance with Art. 41 EEG? Please enclose certificate.
Description of the key energy consumers;
Energy intensity or energy-related complexity category / Which systems/activities or processes consume the majority of energy, and/or which systems/activities or processes would you say are of high energy complexity?
1.
2.
3.
4.
5.
6.
7.
(e.g. consumption of electricity and gas for ventilation systems, gas consumption for drying systems, paper machine, plastic injection moulders, electric smelting furnace)
Energy intensity:Energy input in relation to gross value added / Which systems/activities or processes consume the majority of energy and/or which systems/activities or processes would you say are of high energy complexity?
1.
2.
3.
4.
5.
6.
7.
(e.g. consumption of electricity and gas for ventilation systems, gas consumption for drying systems, paper machine, plastic injection moulders, electric smelting furnace)
Energy intensity:Energy input in relation to gross value added
Energy generation / Does the organization generate energy on site at its location?
1.
2.
(e.g. co-generation: e.g. heating plant, combined heat and power plant): / Does the organization generate energy on site at its location?
1.
2.
(e.g. co-generation: e.g. heating plant, combined heat and power plant):
Introduction of EnMS / When did the organization establish the energy management system at this site?
(The EnMS must have been effective for at least 3 months before the certification audit.)
Since: / When did the organization establish the energy management system at this site?
(The EnMS must have been effective for at least 3 months before the certification audit.)
Since:
Place, date / Signature/company stamp:
crt_f_02.33d.doc
AKB EN 16001/ISO 50001 / Revision 2
Effective:1 August 2011 / Page1of2