8/6/2019 Neighbours Together self assessment and planning form

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Neighbours Together: Let’sGet Started!

Welcome to Neighbours Together! You are one of 140 households,in the Dunbar and East Linton Ward, participating in this

  project. We are all aiming to reduce our energy bills and fuel consumption. So that we can help you achieve your aims, please

  fill in this survey. Please be brutally honest with yourselves - this is

not a test and the information you give will be used to help us - tohelp you - develop and implement your household action plan.*Required 

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Name *Address *

Email or telephone *

How many people over the age of 16 live in your household? * _____ How many under the age of 16 live in your household? * _______ 

How much electricity is used in your household? * circle one:  small house/ flat medium house large house

If you know what your last year’s actual electric kwh used were, please enter this figure here:_____________ 

Does your electricity comes from one of the green tariffs. yes  Name of company____________________________________ 

How much gas is used in your household? Select one option 

small house/ flat

medium

large house

If you know what your last year’s actual gas kwh used were, please enter this figure here:____________ 

What is your main heating fuel? * select one 

gas

electric

other 

If your main heating fuel is oil - how many litres used in the last year?_______________________ 

Have you had a BeGreen energy audit? * Circle one: Yes No 

If you have not had an energy audit done by BeGreen - then we will arrange for you to get a free household audit.

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In a typical week how many showersare taken in your household?

* ________________ 

In a typical week how many baths aretaken in your household?

* ___________________ 

In a typical week how many loads of laundry? * ______________________ 

Do you use a tumble dryer? *  circle one: Never Always Sometimes

How many cars are used by your household? [number of cars used by household] * ____________________ 

• How many small cars? indicate if the mileage is low (6,000 miles), medium (9,000 miles) or high (12,000) for each car  ________________________________________________________________________________________________ 

• How many medium size cars? indicate if the mileage is low (6,000 miles), medium (9,000 miles) or high (12,000) for eachcar______________________________________________________________________________________________ 

• How many large size cars? indicate if the mileage is low (6,000 miles), medium (9,000 miles) or high (12,000) for eachcar.______________________________________________________________________________________________ 

How much of the food that yourhousehold eats is organic? * select oneoption

none

some

most

all

Meat: how much meat/ dairy doesyour household eat? * select one option

above average meat/ dairy

average meat/ dairy

 below average meat/ dairy

lacto - vegetarian

vegan

Food Miles: how much of yourhousehold's foods are producedlocally? * select one option

very little (much foreign/ out of season food)

average

above average

almost all

Food Packaging and processing: howmuch of your households food ispackaged/ processed (e.g. ready meals,tins)? * select one option

above average

average

 below average

very little

Composting: how much do youcompost potato peelings, leftover andunused food? * select one option

none

some

all

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Household Spending: Household spending is directly related to higher household C02 emissions.

How will your household reduce consumption?

ideas:

Thank you - we will get back to you with your CO2 calculations and next steps.

For more information about the Neighbours Together Project please go to www.neighbourstogether.org and or call Sue or Philip on 01368 862 552Bottom of Form

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