Grumman/Butkus Associates 2023 Hospital Energy Survey Submission

Grumman/Butkus Associates 2023 Hospital Energy Survey Submission (CY 2022 Data)
Hospital name for specific location being submitted*
Healthcare group
Name of respondent*

First NameLast Name
Respondent's title/position*
E-mail*
Phone Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Calendar year data*
ENERGY STAR score
Hospital gross area of interior spaces (gsf)*

Facility Operating Characteristics

These parameters affect the type and quantity of energy used in a hospital facility. Items with a red star must be included in the submission.
Absorption cooling
Heat pumps or heat pump chiller
Combined heat and power
Electric heat
On-site laundry
Number of licensed beds
Number of staffed beds
FTEs
Number of patient days
Number of MRI machines
Number of MRI procedures

Usage and Cost Data for Water and Sewer
Quantity of water used per year
Units for water use
Describe the water units
Cost for water supply
Cost for municipal sewer, if separate from water costs
Cost for sanitary district, if separate from water costs
Total cost of water and sewer ($/year)
Calculated water use in gallons per year
Calculated average price for water ($/kgal)

Do not participate in demand responseDiesel generatorsGas generatorsBatteryBuilding automation system relaxes setpoints
Approximately how much revenue is generated from demand response activity?
Should be Empty: