Compressed Air Questionnaire

This form is meant to be completed by someone with working knowledge of the compressed air system. Please complete it to the extent that is conveniently possible. The questions not answered are as important in understanding what scope of supply of the assessment is required as those you do answer.

Name*
First Last
Title*
Company*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone
Is compressed air being metered?
Yes - 4-20ma output? Is trending available on spreadsheet? No - Is all air delivered through single pipe? What is main header size? Steel or copper?
What is the cost per kWh, including demand charge “All-In” Blended Rate?
How many square feet of facility is compressed air utilized?
Hours of operation of compressed air system (i.e., 3 shifts per day M-F, 1 shift S-S)?
Has a leak detection survey been conducted previously? If yes, how long ago?
Has a compressed air audit been conducted previously? If yes, how long ago?
Is the compressed air system in one room / location?
Compressor service company / vendor?
Hit the + symbol to add more rows to the chart.
Hit the + symbol to add more rows to the chart.
Make / Model (serial number, if available Type (Reciprocating, Rotary Screw, Centrifugal) Size HP or kW Online or Backup Annual Hours Year Built Control Type (Variable Speed, Load/ No-Load, Modulation)
Comments on System: Problems, air quality, piping, storage, or major concern we can resolve?
Air Uses In Facility: What major uses of air are you aware of (i.e., Air Blows, Sandblasting, Packaging Equipment…)?
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Make / Model (serial number, if available	Type (Reciprocating, Rotary Screw, Centrifugal)	Size HP or kW	Online or Backup	Annual Hours	Year Built	Control Type (Variable Speed, Load/ No-Load, Modulation)