DOE HQ F 413.2 SEP Energy Performance Improvement Report

Superior Energy Performance® 2018 - Energy Performance Improvement Report
	DOE HQ F 413.2								OMB Control #: 1910-5177
	(10/2017)								Exp. Date: 4/30/2018
	Identifying information:								Guidance
`	1	Company Name							Name of company that owns facility
	2	Unique Facility Name per SEP Certificate							Name of facility. For facilities located on sites with multiple facilities, please provide the unique name that distinguishes this facility
	3	Facility zip code							Zip code where facility is located
	4	Facility boundaries							Please identify the boundary(ies), or how the "facility" was defined for this certification. Example responses include entire facility, subset of production lines, subset of energy consuming systems. See SEP Certification Protocol (link here)
	5	Facility square footage (ft2)							Please provide an estimate of the square footage for the facility boundaries identified in the previous question
	6	Date SEP Stage 2 audit started (month/day/year)							Date SEP Stage 2 audit began
	7	Date Energy Performance Improvement Report completed (month/day/year)							Date this form (Energy Performance Improvement Report) was completed
	Facility contact:								Guidance
	8	First Name							First name of principal contact on facility energy management team
	9	Last Name							Last name of principal contact on facility energy management team
	10	Email							Email of principal contact on facility energy management team
	11	Phone							Phone number of principal contact on facility energy management team
	Verification Body contacts:
	SEP Lead Auditor								Guidance
	12	First Name							First name of SEP Lead Auditor
	13	Last Name							Last name of SEP Lead Auditor
	14	Email							Email of SEP Lead Auditor
	15	Phone							Phone number of SEP Lead Auditor
	16	Organization							SEP Verification Body to which the SEP Lead Auditor is affiliated
	SEP Performance Verifier								Guidance
	17	First Name							First name of SEP Performance Verifier
	18	Last Name							Last name of SEP Performance Verifier
	19	Email							Email of SEP Performance Verifier
	20	Phone							Phone number of SEP Performance Verifier
	21	Organization							SEP Verification Body to which the SEP Performance Verifier is affiliated
	Certification information:
			Start Month/yr	End Month/yr					Guidance
	22	Verified Baseline Period							Start and end month/yr of baseline period.
	23	Verified Reporting Period							Start and end month/yr of reporting period.
	24	Verified SEP Achievement Period							Start and end month/yr for the SEP achievement period.
									Guidance
	25	Certification date (month/day/yr)							Month, day, and year SEP certificate was issued by SEP Verification Body
	26	Verified Reporting Period Energy Performance Improvement % (defined as 1 minus SEnPI)							The Report Period Energy Peformance Improvement is calculated as 1 minus SEnPI where SEnPI is the Superior Performance Energy Performance Indicator for the facility over the reporting period. Source: SEP Measurement and Verification Protocol (link here)
	27	Did the model as verified meet the requirements of the SEP Measurement & Verification (M&V) Protocol? (y/n)							The model requirements can be found in the SEP M&V Protocol: (link here). Please indicate if the model met the appropriate requirements.
	28	Which adjustment model method (forecast, backcast, chaining, standard conditions, other) was used as described in the SEP M&V Protocol?							The adjustment model method used to determine SEnPI. Source: SEP Measurement and Verficiation Protocol (link here)
	29	If "Other" was chosen, did the model require and attain prior approval by the SEP Administrator (y/n)?							All models used for determining energy performance improvements must be approved by the SEP Administrator. For model methods not outlined in the SEP M&V Protocol, please indicate if approval by the SEP Administrator was sought and granted.
	30	If Yes to 29, did the model as verified meet the M&V requirements set forth in the prior approval by the SEP Administrator (y/n)?							If approval to use an alternate model method was granted by the SEP Administrator, please indicate if the model used for verification met the M&V requirements outlined by the SEP Administrator
	List the versions of the SEP normative documents used in this verification:								Guidance
		Title of Normative Document	Version Used in the Verification (revision date)						Revision dates can be found on the cover of the normative document
	31	Superior Energy Performance Measurement & Verification Protocol
	32	Superior Energy Performance Certification Protocol
	Actual and modeled energy consumption information:								Guidance
	Baseline period primary (source) energy consumption (MMBtu)		Actual	Modeled (if chaining or backcasting)	Specify fuel				For each energy source listed below, please provide the actual energy consumption in the baseline period. If the adjustment model method is backcasting or chaining, please provide the modeled baseline period consumption as well. For more information, please see the SEP Measurement and Verfiication Protocol.
	33	Total
	34	Grid Purchased Electricity
	35	On-site Renewable Electricity (e.g., solar, wind)
	36	Purchased Natural gas
	37	Distillate or Light Fuel Oil (#1, 2, & 4)
	38	Residual or Heavy Fuel Oil (# 5, 6, Navy Special & Bunker C)
	39	Coal
	40	On-site Renewable Fuel and/or Recovered Energy (e.g., bio-gas, municipal solid waste, waste fuels, waste gases)
	41	Other Energy Source (please specify)							Please specify the "other energy source" by name
	42	Other Energy Source (please specify)							Please specify the "other energy source" by name
	43	Other Energy Source (please specify)							Please specify the "other energy source" by name
									Guidance
	Reporting period primary (source) energy consumption (MMBtu)		Actual	Modeled (if chaining or forecasting)	Specify fuel				For each energy source listed below, please provide the actual energy consumption in the reporting period. If the adjustement model method is forecasting or chaining, please provide the modeled reporting period consumption as well. For more information, please see the SEP Measurement and Verfiication Protocol.
	44	Total
	45	Grid Purchased Electricity
	46	On-site Renewable Electricity (e.g., solar, wind)
	47	Purchased Natural gas
	48	Distillate or Light Fuel Oil (#1, 2, & 4)
	49	Residual or Heavy Fuel Oil (# 5, 6, Navy Special & Bunker C)
	50	Coal
	51	On-site Renewable Fuel and/or Recovered Energy (e.g., bio-gas, municipal solid waste, waste fuels, waste gases)
	52	Other Energy Source (please specify)							Please specify the "other energy source" by name
	53	Other Energy Source (please specify)							Please specify the "other energy source" by name
	54	Other Energy Source (please specify)							Please specify the "other energy source" by name
	55. Model validity and relevant Variables
		Energy source (choose from list)	If "other" please specify	R^2 for model of energy source	p-value from F test for overall model fit	Relevant variables in model for the energy source (e.g., production, HDD, CDD. Etc.)	p-value for relevant variable in model for this energy source		Guidance
									For each modeled energy source, please provide the parameters to test model validity: R^2 value for the model for the energy source, the p-value from the F-tes of the overall model, the relevant variables included in the model for the energy source, and the p-vaue for each of the relevant variables. NOTE: Each modeled energy source will have one R^2 value, one overall model p-value, multiple relevant variables and a p-value for each relevant variable. The energy source, specification of "other", the R^2, and the overall model p-value, only needs to be completed for the first relevant variable entry, and does not need to be completed for successive relevant variable entries for the same model
			First ISO 50001 and SEP certification	ISO 50001 recertification and first SEP certification OR upgrade to SEP mid-ISO 50001 certification	ISO 50001 and SEP recertification				Guidance
	56	Certification status for this facility (check one box, and follow instructions for next steps per your selection)							Please indicate this facility's ISO 50001 and SEP certification history. Your answer to this question will determine which SEP Voluntary Cost/Benefit form we request the facility to complete next. All facilities are requested, but not required, to fill out one of SEP Voluntary Cost/Benefit Forms 1 - 3 as well as SEP Voluntary Cost/Benefit Form 4.
		Instructions for next steps	Please complete SEP Voluntary Cost/Benefit Form 1	Please complete SEP Voluntary Cost/Benefit Form 2	Please complete SEP Voluntary Cost/Benefit Form 3
		Public reporting burden for this collection of information is estimated to average 1.5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Records & Privacy Management Division, IM-23, Paperwork Reduction Project (OMB control # 1910-5177), U.S. Department of Energy, 1000 Independence Ave SW, Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project (OMB control # 1910-5177), Washington, DC 20503. The US DOE, as the Superior Energy Performance (SEP) Program Administrator within the United States, maintains the confidentiality of proprietary energy and production related data as proprietary that is submitted to the SEP program by SEP certified facilities, to the fullest extent of US federal law. Data included within the SEP Application form, SEP Energy Performance Improvement Report, SEP Voluntary Cost Benefit Form, and any other forms or data shared with the US DOE will not be released publicly. The US DOE will make public the following information about each SEP certified facility: 1. Facility name 2. Facility location (city, state) 3. Verified achievement period energy performance improvement a. The SEP certified facility can elect if energy performance improvement is reported, or not. If the energy performance improvement is reported, the facility has the option to report as an absolute value of energy savings (BTU), a percentage value as compared to the energy baseline (SEnPI), or both. 4. Verified achievement period length 5. Certification date (month/year) US DOE will, from time-to-time, publicly share aggregate, program-wide metrics, such as number of SEP certified facilities, and annual and cumulative SEP program energy savings without revealing data or analysis that could lead to the identification of specific facilities. US DOE may use data to study the effectiveness and impact of the SEP program. Results from such analysis will be made public only if participating organization anonymity can be ensured. The participating organization may be asked if they wish to voluntarily participate in the formation of case studies and other activities regarding the SEP program. All data provided to US DOE is subject to the Freedom of Information Act (FOIA), however, US DOE will notify the SEP certified facility if a FOIA request has been submitted for which their data might be responsive. US DOE will consult with the SEP certified facility and ensure the facility has an opportunity to inform US DOE what data they view is proprietary. US DOE will review the SEP certified facility’s suggestions and will not release to the public any data US DOE deems proprietary.