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212339198782Energy Audit ReportEnergy Audit Voucher Scheme For office use onlyReference Number:Date Received by ME:Name of Beneficiary:Name of Energy Auditor:Complete Energy Audit Report: Approved by E&WA (Full Name):Approved by E&WA (Signature): Date Approved by E&WA: Details of the undertaking being auditedCompany Name (the details in this section should be identical to those specified in the Energy Voucher issued by Malta Enterprise) FORMTEXT ?????Company Number / ID or other reference FORMTEXT ?????VAT Number FORMTEXT ?????Registered Address FORMTEXT ?????Address of Beneficiary where audit is being undertaken FORMTEXT ?????General E-mail Address FORMTEXT ?????Contact DetailsContact Person FORMTEXT ?????Designation FORMTEXT ?????E-mail Address FORMTEXT ?????Telephone/Mobile Number FORMTEXT ????? Details of the Energy Auditor Full Name FORMTEXT ?????Qualifications of Energy Auditor FORMTEXT ?????E-mail Address FORMTEXT ?????Telephone Number FORMTEXT ?????Background information on the organisationGeneral information on the organisation FORMTEXT ?????NACE Code FORMTEXT ?????Number of staff headcountNumber of Annual Work Units (AWU) FORMTEXT ?????Full-timers FORMTEXT ?????Part-timers FORMTEXT ?????Total area of premises FORMTEXT ????? m2Total annual business hours FORMTEXT ????? hrsMain Energy Consuming/Generating Equipment 4.1 Lighting FORMCHECKBOX Incandescent FORMTEXT ????? Watts FORMCHECKBOX Energy Savings FORMTEXT ????? Watts6 FORMCHECKBOX LEDs FORMTEXT ????? Watts6 FORMCHECKBOX Others FORMTEXT ????? Watts6Please Specify FORMTEXT ????? - FORMTEXT ????? Watts64.2 Air conditioning Used for: FORMCHECKBOX Cooling FORMCHECKBOX Heating FORMCHECKBOX Both Total heated cooling area: FORMTEXT ????? m2 FORMCHECKBOX Reversible Split Unit FORMTEXT ????? (Btu) or FORMTEXT ????? (kW) or FORMTEXT ????? (HP)Year of installation FORMTEXT ?????Please provide details above if there are more units installed FORMTEXT ????? FORMCHECKBOX Centralised Air Condition FORMTEXT ????? Qty FORMTEXT ????? Size (Btu) FORMTEXT ????? Size (kW) FORMTEXT ????? Size (HP)Year of Installation FORMTEXT ?????Please provide details above if there are more units installed FORMTEXT ????? FORMCHECKBOX Other FORMTEXT ????? Size (kW) FORMTEXT ????? Units Year of Installation FORMTEXT ????? 4.3 Refrigeration FORMCHECKBOX Display cabinet FORMTEXT ????? Btu FORMTEXT ????? WattsPlease provide details above if there are more units installed FORMTEXT ????? FORMCHECKBOX Upright freezer FORMTEXT ????? Btu FORMTEXT ????? WattsPlease provide details above if there are more units installed FORMTEXT ????? FORMCHECKBOX Chest Freezer FORMTEXT ????? Btu FORMTEXT ????? WattsPlease provide details above if there are more units installed FORMTEXT ????? FORMCHECKBOX Cold Room FORMTEXT ????? Btu FORMTEXT ????? WattsPlease provide details above if there are more units installed FORMTEXT ????? FORMCHECKBOX Others (Please specify) FORMTEXT ????? Btu FORMTEXT ????? WattsPlease provide details above if there are more units installed FORMTEXT ????? 4.4 Water Heating FORMCHECKBOX Electric Heater FORMTEXT ????? WattsPlease provide details above if there are more units installed FORMTEXT ????? FORMCHECKBOX Boiler FORMTEXT ????? WattsPlease provide details above if there are more units installed FORMTEXT ????? Other Energy Intensive Equipment (Please provide details) FORMTEXT ????? 4.5 Installed RES FORMCHECKBOX Photovoltaics FORMTEXT ????? kWp FORMCHECKBOX Solar Water Heater FORMCHECKBOX Vacuum Tube FORMCHECKBOX Flat PlateCollector Area FORMTEXT ????? m2 FORMCHECKBOX Other (Please Specify) FORMTEXT ?????Energy Consumption 5.1 Annual Electricity Consumption FORMTEXT ????? kWh5.2Annual Fuel Consumption per fuel type FORMTEXT ????? litres of FORMTEXT ????? 5.3Annual Gas Consumption FORMTEXT ????? kgor FORMTEXT ????? litres – bulk or FORMTEXT ????? number of 12kg cylinders or FORMTEXT ????? number of 15kg cylinders or FORMTEXT ????? number of 25kg cylinders 5.4Annual Water Consumption FORMTEXT ?????m3 5.5Annual average Hot Water Demand FORMTEXT ?????m35.6Key Energy Performance Indicators (based on previous year) FORMTEXT ?????5.7Comparison of Energy Performance Indicators for the last 3 years FORMTEXT ?????Energy Audit Analysis Description of Energy Audit (Define scope and boundaries of audit, audited objectives and timeframes FORMTEXT ?????The Energy Audit is to include:High level review of consumptionComparison with available benchmarks to identify high energy consumption or inefficienciesIdentification of energy savings through behavioural changesIdentification of low cost and easily quantifiable energy improvementsIdentification of more capital intensive improvement opportunitiesIndicative or typical savings in kWhRanking of opportunities for improving energy performanceRequired investment and pay back periods for the identified energy savings opportunities.Other Identify that part of the report and/or data that the undertaking considers commercially sensitive. FORMTEXT ?????Signatures8.1This Report has been duly filled in and confirmed correct by the Energy Auditor:Name of Energy Auditor (full name):Name of Undertaking being representedby the Energy Auditor (if applicable):Signature of Energy Auditor:Click here to enter a date.Date:8.2On behalf of the undertaking whose facility have been covered by this audit I hereby confirm that the Energy Auditor has adequately explained the details of the Energy Audit Analysis in this report, particularly any energy efficiency issues and measures that may be adopted by the Beneficiary in order to enhance energy efficiency.Name and Surname of signatoryauthorised to represent the Beneficiary (CAPITAL LETTERS):Position in Establishment:Signature:Click here to enter a date.Date: ................
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