Parish Heating Survey
A copy of this form will be shared with the Zero Emissions Task Force. Questions may be sent to DOVTZeroEmissionsTaskForce@gmail.com.
Date
*
-
Month
-
Day
Year
Date
Congregation
*
Name, Town
Buildings and Their Heating Sources
Building 1 (Church, Hall, Rectory, Etc.)
*
Primary/Secondary Heating System
*
Identify if this is your primary or secondary heating source.
Heating System Type
Identify if furnace, boiler, air source heat pump, geothermal, etc. and whether delivered as ducted forced hot air, radiators, radiant floor, etc.
Fuel Type
Identify if heating oil, propane, natural gas, wood pellets, electricity (including if producing solar on site or in a community solar project) etc.
Year Last Replaced
Notes on Hot Water Heating
Identify the different water heating systems and their energy sources.
Expand for More Buildings
Building 2 (Church, Hall, Rectory, Etc.)
Primary/Secondary Heating System
Heating System Type
Fuel Type
Year Last Replaced
Building 3 (Church, Hall, Rectory, Etc.)
Primary/Secondary Heating Source
Heating System Type
Fuel Type
Year Last Replaced
Building 4 (Church, Hall, Rectory, Etc.)
Primary/Secondary Heating Source
Heating System Type
Fuel Type
Year Last Replaced
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Contact Information
Name of Group/Committee in Charge of Building Energy Review
Name of Group/Committee in Charge of Building Review
Contact #1
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Contact #2
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
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