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Facility Management Needs Analysis

To better assess your needs, please take a moment to complete this brief questionnaire
(This survey will take less than five minutes)

Tell Us About You and Your Organization and Needs
Name
First Name Last Name
Company Name
Phone Number
- Area Code Phone Number

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail
How did you hear about our services?
What kind of industry are you in?
Does your organization incorporate a single facility or multiple facilities?

Single Multiple
What is the square footage of the buildings (approximate)?
How many employees do you have (approximate)?
How soon would you like to get started?
Please Choose True or False for Each Question

(If you do not know the answer to a question, please choose "False")
We have benchmarked our utility costs by entering 12-24 months of our costs into EPA's Energy Star Portfolio Manager.
We have completed an ASHRAE Level 1 energy audit.
We have completed an ASHRAE Level 2 energy audit.
We have completed an ASHRAE Level 3 energy audit.
We have developed a five-year capital investment plan for utility related investments.
If you have completed a five-year capital investment plan for utility related investments, does it include payback periods and ROI studies? (True=Yes)
We have completed a cost segregation study to extract and accelerate depreciation on short - medium life assets.
We have taken advantage of 179D Federal tax deductions for renovations that include lighting, HVAC and building envelope improvements.
We are receiving sewer credits for cooling towers, irrigation, process water and similar assets or services.
Our organization has a written "Resource and Energy Conservation Program".
Our Chief Engineer, maintenance staff and Facility Manager have been trained in asset planning and energy & resource conservation.
Rank the Following Potential Roadblocks:

(1 represents a "great challenge", 5 represents "not a challenge for my organization")

Lack of management support

	1	2	3	4	5
Great Challenge						Not a Challenge for My Organization

Lack of employee support

	1	2	3	4	5
Great Challenge						Not a Challenge for My Organization

Lack of direction (I don't know where to start)

	1	2	3	4	5
Great Challenge						Not a Challenge for My Organization

Insufficient budget

	1	2	3	4	5
Great Challenge						Not a Challenge for My Organization

Not enough time (To many other responsibilities)

	1	2	3	4	5
Great Challenge						Not a Challenge for My Organization

Would you like us to prepare a no-obligation proposal for FM services?

Yes - please! No
Should be Empty:

Facility Management Needs Analysis