Your first step to a greener organization.
                                  
 Your First Step To A Green Organization.

Assessment Survey

Survey Site 1

Please complete this survey of your facility to the best of your ability. The more complete information we receive in advance of our site visit, the more efficient the assessment process will be. If a particular field does not apply to your facility, please indicate so with "N/A."

Company:
Contact First Name:
Contact Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Contact Phone:
Email:
Hours of Operation:
Number of Employees:
Number of Shifts:
Approx. Sq. Footage:
Number of Entrances:
Number of Exits:
Number of Restrooms:
Number of Kitchens:
Name of Electrical Utility:
Name of Gas Utility:
Name of Water Utility:
Waste Disposal Contractor:
Recycling Contractor:
Janitorial Contractor:
Landscape Contractor:
 Do you offer: Employee Carpool Incentive?
 Do you offer: Office Recycling Program?
 Do you offer: Flexible Employee Hours?
Comments: