Information
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Contractor Company Name:
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Project Name:
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Project Number:
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Industry / Sector:
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Location:
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From Completed by:
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Date Completed:
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E-mail:
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Phone:
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Month / Year
Data collection form
Data Items
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Amount - the amount of the substance consumed in the time period
Unit - The unit of measurement of the substance (Litre/KWh etc.)
Data source - the source of the measurement (invoice, direct measurement, estimate etc)
Cost - direct cost of energy sources
Electricity:
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Purchased from grid:
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Amount (kWh)
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Data source
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Purchased from renewable sources
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Amount (kWh)
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Data source
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Liquefied Natural Gas (LNG) - used for transport <br>
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Amount (KL)
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Data Source
Transport
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Diesel - used for transport <br>
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Amount (kWh)
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Data Source
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Biodiesel (B20) - used for transport <br>
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Amount (KL)
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Data Source
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Petrol (Fuel Oil) - used for transport <br>
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Amount (KL)
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Data Source
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Liquified Petroleum Gas (LPG) - used for transport <br>
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Amount (KL)
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Data Source
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Kerosene for use as fuel in aircraft <br>
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Amount (KL)
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Data Source
Stationary
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Diesel - used for stationary energy <br>
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Amount (KL)
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Data Source
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Biodiesel (B20) - used for stationary energy <br>
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Amount (KL)
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Data Source
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Petrol (Fuel Oil) - used for stationary energy <br>
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Amount (KL)
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Data Source
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Ethanol (E10) - used for stationary energy <br>
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Amount (KL)
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Data Source
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Liquefied Petroleum Gas - used for stationary energy <br>
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Amount (KL)
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Data Source
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Liquefied Natural Gas (LNG) - used for stationary energy <br>
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Amount (KL)
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Data Source
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Combustion of other petroleum products<br>
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Amount (KL)
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Data Source
Other consumption of fossil fuels
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Combustion of other petroleum products<br>
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Amount (KL)
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Data Source
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Acetylene <br>
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Amount (m³)
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Data Source
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Sovlents (mineral tupentine or white spirit)<br>
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Amount (KL)
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Data Source
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Petroluem based greases <br>
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Amount (KL)
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Data Source
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Bitumen <br>
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Amount (T)
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Data Source
Other reportable substances
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Sulphur hexafluoride (SF6) High-Voltage equipment <br>
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Amount (m³)
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Data Source
Water
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Water used/ consumed <br>
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Amount (KL)
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Data Source
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Water recycled <br>
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Amount (KL)
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Data Source
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Water discharged <br><br>
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Amount (KL)
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Data Source
Waste
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Waste sent to landfill <br>
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Amount (T)
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Data Source
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Waste reused/ recycled <br>
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Amount (T)
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Data Source
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Waste composted <br>
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Amount (T)
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Data Source
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Waste sent to liquid waste facility <br>
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Amount (KL)
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Data Source
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Waste sent to hazardous waste facility <br>
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Amount (T)
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Data Source
