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System Survey Form

General Info

Company Name

Contact Name

Address

Email

Phone

Position

Dust Collection System

System Name or #

Fan Motor HP

Power Company

Electricity Cost (cents/kWh)

Fan Operation hrs/day

Fan Operation days/week

Fan Operation weeks/year

Main Duct Diameter (" or mm)

Workstations

Workstation 1 Name

Ave Active Utilization (%) - W1

Workstation 2 Name

Ave Active Utilization (%) - W2

Workstation 3 Name

Ave Active Utilization (%) - W3

Workstation 4 Name

Ave Active Utilization (%) - W4

Workstation 5 Name

Ave Active Utilization (%) - W5

Workstation 6 Name

Ave Active Utilization (%) - W6

Workstation 7 Name

Ave Active Utilization (%) - W7

Workstation 8 Name

Ave Active Utilization (%) - W8

Workstation 9 Name

Ave Active Utilization (%) - W9

Workstation 10 Name

Ave Active Utilization (%) - W10

Workstation 11 Name

Ave Active Utilization (%) - W11

Workstation 12 Name

Ave Active Utilization (%) - W12

Workstation 13 Name

Ave Active Utilization (%) - W13

Workstation 14 Name

Ave Active Utilization (%) - W14

Workstation 15 Name

Ave Active Utilization (%) - W15

Workstation 16 Name

Ave Active Utilization (%) - W16

Workstation 17 Name

Ave Active Utilization (%) - W17

Workstation 18 Name

Ave Active Utilization (%) - W18

Workstation 19 Name

Ave Active Utilization (%) - W19

Workstation 20 Name

Ave Active Utilization (%) - W20

Thank you! We’ll be in touch.

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