DRAFT FUTUREPAST WORK PRODUCT FOR NSF-ISR’S GHG PROGRAM

KEY FACTS ABOUT YOUR GHG INVENTORY

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please complete this form to the best of your knowledge.

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Contact Information

Company:

Contact: Title:

Phone No: Ext: Fax No: E-mail:

Address:

City/State/Country/Zip Code:

Check whether inclusion of facilities in your inventory is based on Control ____ or Equity share ____.

Total number of facilities included within this GHG Inventory: ________. Please provide their locations (city, state, postal code, country). (Attach additional list, as necessary).

______

______

______

______

______

For each included facility, please provide, in as much detail as practicable, the following information:

oPrimary SIC or NAICS code(s)

oOperational boundaries of each facility

oGHG emissions and removals from/to sources, sinks or reservoirs within the following categories:

Direct emissions

Energy (electricity, steam) indirect emissions (i.e. imported energy not generated on-site)

Other indirect emissions

Check the quantification methodology(ies) that apply to your inventory:

  • ____ GHG activity data multiplied by GHG emission or removal factors
  • ____ Use of models – Please specify type: ______
  • ____ Site-specific correlations
  • ____ Mass balance approach
  • ____ Measurement, continuous
  • ____ Measurement, intermittent

Please explain if your inventory includes any documented exclusions of emissions or removals from the described operational boundaries

Has GHG information been quantified and reported in accordance with documented operational and information management procedures?

  • ____ Yes
  • ____ No

Has an uncertainty assessment been completed with respect to the quantification of GHG emissions and removals?

  • ____ Yes
  • ____ No

Are GHG inventory quantification practices and results subject to regular internal auditing, or have they been previously audited by a third-party?

  • ____ Yes
  • ____ No

The operational boundaries of this inventory Do ____ / Do Not ____ coincide with the organizational boundaries used for financial accounting and reporting (e.g. SEC 10-K forms, etc.)

Indicate what Protocol, Standard, or GHG Program has been adhered to in establishing the GHG inventory:

  • ____ WBCSD/WRI Greenhouse Gas Protocol
  • ____ ISO/DIS 14064-1 “Specification with guidance at the organization level for quantification and reporting of greenhouse gas emissions and removals”
  • ____ U.S. Department of Energy “1605b” program
  • ____ U.S. Environmental Protection Agency “Climate Leaders” program
  • ____ California Climate Action Registry
  • ____ European Union Emissions Trading Scheme
  • ____ Other: Please specify: ______

Indicate Base Year, if applicable: ________. Date the Base Year was last adjusted: __________.

Please indicate what information you desire to be independently verified by NSF-ISR:

____ Check if this information has been summarized in the form of a written report.

Check the level of assurance you are seeking for NSF-ISR’s GHG Statement:

  • ____ High (e.g. “We believe with high assurance that [Insert name ofResponsible Party]’s GHG assertion is free from material discrepancies . . .”)
  • ____ Moderate (e.g. “Nothing has come to our attention that causes us to believe that [Insert name ofResponsible Party]’s GHG assertion is not, in all material respects, in accordance with the stated quantification and reporting protocols . . .”)
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