Senior Living Center Energy Benchmark Form
Facility Information
Facility Name
Address
City
State
ZIP Code
Contact Name
Contact Phone
Contact Email
Building Characteristics
Year Built
Number of Floors
Total Square Footage
Average Occupancy (%)
Total Number of Units
Facility Type
Independent Living
Assisted Living
Memory Care
Skilled Nursing
Other
Energy Usage Data
Billing Year
Annual Electricity Use (kWh)
Annual Natural Gas Use (therms)
Annual Fuel Oil Use (gallons)
Annual Water Use (CCF)
Additional Information
Comments or Notes