Manufacturing and Energy Division, Energy Section

Annual Industrial Consumption of Energy Survey 2009

In all correspondence, quote number below.
Establishment Number
Contact Information
Correct contact information if necessary

Confidential when completed
Reporting Period January – December 2009

Purpose of the survey

The purpose of this survey is to obtain information on the demand for energy in Canada. This information serves as an important indicator of Canadian economic performance and is used by all levels of government in establishing informed policies in the energy area. The private sector also uses this information in the corporate decision-making process.

Authority

This survey is conducted under the authority of the Statistics Act, Revised Statutes of Canada, 1985, Chapter S19. Completion of this questionnaire is a legal requirement under this Act.

Confidentiality

Statistics Canada is prohibited by law from releasing any information from this survey which would identify any person, business, or organization, or any information related to them, unless consent has been given by the respondent or as permitted by the Statistics Act. The confidentiality provisions of the Statistics Act are not affected by either the Access to Information Act or any other legislation. Information from this survey will be used for statistical purposes only and will be published in aggregate form only.

Data sharing agreements

To reduce respondent burden, Statistics Canada has entered into data sharing agreements with provincial and territorial statistical agencies and other government organizations, who must keep the data confidential and use them only for statistical purposes. For further information on data sharing, please see the enclosed reporting guide.

Data Linkage

To enhance the data from this survey and for the purpose of statistical studies, Statistical Canada may combine it with information from other surveys or from administrative sources.

Retention

Please keep a copy of the completed questionnaire with your secure records until March 31, 2012.

Completion and return

Complete and return within 20 days after the receipt of this questionnaire. If you require assistance in the completion of the questionnaire, contact tool free
1-800-461-1662 or by fax 1-800-787-3161.
Statistics Canada advises you that there could be a risk of disclosure during the facsimile or other electronic transmission. However, upon receipt of your information, Statistics Canada will provide the guaranteed level of protection afforded all information collected under the authority if the Statistics Act.

Who should complete this questionnaire?

An engineer, a production manager, an operation manager or someone knowledgeable about the energy consumption and production process of this enterprise should complete this questionnaire.

Certification

I certify that the information contained herein is complete and correct to the best of my knowledge.

Signature:
Date (DD/MM/YYYY):
Name of signer (please print):
Official position of signer:
Name of contact for further information:
E-mail address:
Fax:
Telephone and Extension:

Units of Measure

Instructions: The following is a list of possible units of measure. For each energy form, select the unit of measurement which you are reporting in and enter the corresponding abbreviation provided (see below in brackets), in the column titled Unit of Measure

Section 1

Type of energy commodity	Unit of measure	Amount consumed
Please report only the consumed portion		As fuel	To produce steam for sale	To produce electricity	For non-energy use
Electricity
Purchased
Self-generated
Natural gas
Propane
Middle distillates
Diesel (on-site only)
Light fuel oil
Kerosene and other middle distillates
Heavy fuel oil
Canadian
Foreign
Wood and wood waste
Spent pulping liquor
Refuse (specify type)
Steam
Self-generated
Purchased

Section 2

Did you consume any coal or coal by-products (such as bituminous coal, lignite, anthracite, coal coke and coal by-products)? No > Go to Section 3 Yes
Type of energy commodity	Unit of measure	Amount consumed
Please report only the consumed portion / Veuillez déclarer seulement la partie consommée		As fuel	To produce steam for sale	To produce electricity	For non-energy use
Canadian coal
Bituminous
Sub-bituminous
Lignite
Foreign coal
Bituminous
Sub-bituminous
Anthracite
Coal coke
Canadian
Foreign
Coal by-products
Coal tar
Light coal oil
Coke oven gas

Section 3

Did you consume any petroleum coke, refinery fuel gas, coke on catalyst, bitumen emulsion, ethane, butane, naphtha, by-product gas or flared gas? No > Go to Section 4 Yes
Type of energy commodity	Unit of measure	Amount consumed
Please report only the consumed portion		As fuel	To produce steam for sale	To produce electricity	For non-energy use
Petroleum coke
Canadian
Foreign
Refinery fuel gas
Coke on catalyst
Bitumen emulsion (orimulsion)
Ethane
Butane
Naphtha
By-product gas
Flared gas

Section 4 Other type of energy commodity

Did you consume any other type of fuel or energy not listed above? No > Go to Section 5 Yes
Type of energy commodity	Unit of measure	Amount consumed
Please report only the consumed portion		As fuel	To produce steam for sale	To produce electricity	For non-energy use
Specify type, quantity consumed and unit of measure

Section 5 Reasons for changes in energy consumption

Statistics Canada compares responses to this questionnaire with those from previous years. In order to reduce the necessity for further inquiries, please check the boxes that best describe the reasons for significant changes in your energy consumption from the previous year, and provide an explanation.
New contract or loss of contract
Organizational change
Plant expansion or contraction
Change in product line
Fuel switch
Fuel price changes
Technology changes
Process changes
Awareness of energy efficiency
Other (specify)

Section 6 Steam sales

Did you sell steam to external clients? No > Thank you for your cooperation Yes > Please report, in gigajoules, the amount sold to external clients.
Residential (include apartment buildings)
Agriculture
Paper manufacturing
Chemical manufacturing
All other manufacturing
Public administration
Commercial and other institutional
Total

Thank you for your cooperation