2019 ENERGY CHAMPION AWARD APPLICATION

The Energy Champion Award is given out once per year to honor an individual or team at a single facility (acute care hospital or medical office building as defined by Energy Star) who has demonstrated outstanding leadership in energy efficiency. Hospitals and medical office buildings participating in Energy to Care that have an ASHE member on staff are eligible for this prestigious award.

The facility that wins will be recognized with an award and will be honored nationally in 2019.

Submitting this form to ASHE verifies that 1) your facility would like to be considered for the Energy Champion Award and 2) that your energy use data shared with the Energy to Care program is accurate.

Please fill out this application in its entirety. Incomplete applications will not be considered. APPLICATIONS ARE DUE APRIL 1, 2019.

For help, contact helpdesk@energytocare.com.

















Please include the first and last name. The facility contact must be an ASHE member.













Data recorded in this section of the application comes from your Energy Star Portfolio Manager account. This section includes energy use in the performance year (2018) and the baseline year (2017).




Answer should be in kBTUs/sf/year


Answer should be in kBTUs/sf/year


To calculate percent reduction in EUI, use this formula:
(2017 SOURCE EUI - 2018 SOURCE EUI) / 2017 SOURCE EUI -- shown as a percentage




To apply for the Energy Champion Award, your data must be verified by a licensed professional engineer (PE). Please include the PE reviewer information here.








Include city, state, and zip code










Please answer the following essay questions about your energy efficiency work.


Please limit your answer to 200 words.


Please limit your answer to 200 words.


Please limit your answer to 200 words.


Please limit your answer to 200 words.



Energy Champion award winner receives an award to display in their facility as well as an individual award to display for the facility manager or group responsible for the energy reduction.

We need to know how you would like your award to appear if you are selected as the winner.



The Energy Champion can be a single person or a team, i.e. Joe Smith or XYZ Hospital Facilities Department.







ASHE will notify your hospital executive if you win the Energy Champion Award.

Please provide the contact information of the senior leader that should be notified.



























By typing my name below, I confirm that the energy consumption data that I have entered into my Portfolio Manager account for the facility and timeframe listed above is accurate to the best of my knowledge. I have reviewed my data and confirm that any identified input errors have been corrected. I understand that if selected as the Energy Champion, ASHE will publicize my award and share our energy efficiency successes. Typing my name below will act as my digital signature for this application.


Press the blue "submit" button below to submit your completed application. Incomplete applications will not be considered.






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