Mass and Energy Assessment Form
Complete this Mass and Energy Assessment Form to evaluate your site or process’s mass and energy performance. Please answer each section as accurately as possible.
Site or Process Name
*
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Operation
*
Please Select
Manufacturing
Processing
Assembly
Packaging
Other
Mass Balance Table (Input/Output)
*
Rows
Input (kg)
Output (kg)
Raw Materials
Products
Waste
Other
Energy Balance Table (Input/Output)
*
Rows
Input (kWh)
Output (kWh)
Electricity
Fuels
Heat Losses
Other
How would you rate current mass efficiency?
*
1
2
3
4
5
How would you rate current energy efficiency?
*
1
2
3
4
5
Main sources of mass or energy loss (select all that apply)
*
Leaks
Heat Loss
Equipment Inefficiency
Process Design
Other
Overall mass and energy performance
*
Very Poor
1
2
3
4
Excellent
5
1 is Very Poor, 5 is Excellent
Key opportunities for improvement
Submit Assessment
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