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WHOLEGRAIN DIGITAL - TEAM MEMBER CARBON FOOTPRINT FORM
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Please enter data into cells this colour
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TEAM MEMBER DETAILS
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Name:
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Start month:
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1. TEAM MEMBER COMMUTING
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1. A. Journey from home to office
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Please add details of the regular commute you made from home to the office. If you moved house during this time, you can add additional commutes to the right.
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Regular commute to officeADDITIONAL: Regular commute to officeADDITIONAL: Regular commute tooffice
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Date range you took this commute: [Starting month][Finishing month]Date range you took this commute: [Starting month][Finishing month]Date range you took this commute: [Starting month][Finishing month]
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LegFrom (location)To (location)Mode of transportAvge no. of journeys / monthLegFrom (location)To (location)Mode of transportAvge no. of journeys / monthLegFrom (location)To (location)Mode of transportAvge no. of journeys / month
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2. At-home energy consumption
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This will be used to calculate the carbon footprint of your working time at home. You can find this information your supplier statements or, if your provider uses a Smart Meter, you may find it on an app or the supplier's website
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2017Electricity
(consumption in kWh)		Gas
(consumption in kWh)
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April
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May
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June
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July
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August
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September
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October
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November
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December
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2018Electricity
(consumption in kWh)		Gas
(consumption in kWh)
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January
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February
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March
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April
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May
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June
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July
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August
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September
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October
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November
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December
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2.B. Energy mix at home
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Please include details of your energy sources at home.
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Mix 1: Current arrangementMix 2: Current arrangementMix 3: Current arrangement
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ElectricityGasCommentsElectricityGasCommentsElectricityGasComments
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Energy company nameEnergy company nameEnergy company name
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Name of energy planName of energy planName of energy plan
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Plan % renewablePlan % renewablePlan % renewable
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Any direct onsite production (e.g. solar)?Any direct onsite production (e.g. solar)?Any direct onsite production (e.g. solar)?
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If any onsite, what % of total consumption does this provide?If any onsite, what % of total consumption does this provide?If any onsite, what % of total consumption does this provide?
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Month & Year this arrangement commenced?Month & Year this arrangement commenced?Month & Year this arrangement commenced?
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In addition to your work computer, do you use any additional equipment when working at home? E.g. monitors. Add any details. Month & Year this arrangement ended?Month & Year this arrangement ended?
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3. Computer details
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Please include details of your work computers back to and including April 2017.
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3.A. Current computer
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Month of first use:
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Brand:
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Model:
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3.B. Previous computer
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Month of first use
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Month of last use
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Brand:
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Model:
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3.C. Previous computer
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Month of first use
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Month of last use
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Brand:
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Model:
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End of form
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