Annual Survey of Manufacturing Industries - Long Questionnaire - 2016

Business or organization and contact information - Question identifier:1

Please verify or provide the business or organization's legal and operating name and correct where needed. Note: Legal name modifications should only be done to correct a spelling error or typo.

Legal name

Operating name (if applicable)

Business or organization and contact information - Question identifier:2

Please verify or provide the contact information of the designated business or organization contact person for this questionnaire and correct where needed. Note: The designated contact person is the person who should receive this questionnaire. The designated contact person may not always be the one who actually completes the questionnaire.

First name

Last name

Title

Preferred language of communication

Mailing address (number and street)

City

Province, territory or state

Postal code or ZIP code Example: A9A 9A9 or 12345-1234

Country

Email address Example: user@example.gov.ca

Telephone number (including area code) Example: 123-123-1234

Extension number (if applicable)

Fax number (including area code) Example: 123-123-1234

Business or organization and contact information - Question identifier:3

Please verify or provide the current operational status of the business or organization identified by the legal and operating name above.

.

• 1: Operational
• 2: Not currently operational e.g., temporarily or permanently closed, change of ownership

Why is this business or organization not currently operational?

• 1: Seasonal operations
• 2: Ceased operations
• 3: Sold operations
• 4: Amalgamated with (an) other business(es) or organization(s)
• 5: Temporarily inactive but will re-open
• 6: No longer operating due to other reason(s)

Business or organization and contact information - Question identifier:3a

Seasonal operations

When did this business or organization close for the season?

When does this business or organization expect to resume operations?
Date:
Example: YYYY-MM-DD

Business or organization and contact information - Question identifier:3b

Ceased operations

When did this business or organization cease operations?
Date:
Example: YYYY-MM-DD

Why did this business or organization cease operations?

• 1: Bankruptcy
• 2: Liquidation
• 3: Dissolution
• 4: Other reasons - specify:

Why did this business or organization cease operations? Other reasons - specify

Business or organization and contact information - Question identifier:3c

Sold operations

When was this business or organization sold?
Date:
Example: YYYY-MM-DD

What is the legal name of the buyer?

Business or organization and contact information - Question identifier:3d

Amalgamated with (an) other business(es) or organization(s)

When did this business or organization amalgamate?

What is the legal name of the resulting or continuing business or organization?

What is (are) the legal name(s) of the other amalgamated business(es) or organization(s)?

Business or organization and contact information - Question identifier:3e

Temporarily inactive but will re-open

When did this business or organization become temporarily inactive?

When does this business or organization expect to resume operations?

Why is this business or organization temporarily inactive?

Business or organization and contact information - Question identifier:3f

No longer operating due to other reason(s)

When did this business or organization cease operations?
Date:
Example: YYYY-MM-DD

Why did this business or organization cease operations?

Main activity - Question identifier:4

Please verify or provide the current main activity of the business or organization identified by the legal and operating name above. Note: The described activity was assigned using the North American Industry Classification System (NAICS).

.

• 1: This is the current main activity.
• 2: This is not the current main activity.

This is not the current main activity - Please provide a brief but precise description of this business or organization's main activity. e.g., breakfast cereal manufacturing, shoe store, software development

Main activity - Question identifier:5

You indicated that is not the current main activity. Was this business or organization's main activity ever classified as: ?

• 1: Yes
• 2: No

Main activity - Question identifier:5a

When did the main activity change?

Main activity - Question identifier:6

Please search and select the industry classification code that best corresponds to this business or organization's main activity. How to search:
- if desired, you can filter the search results by first selecting this business or organization's activity sector
- enter keywords or a brief description that best describes this business or organization main activity
- press the Search button to search the database for an activity that best matches the keywords or description you provided
- then select an activity from the list.

Select this business or organization's activity sector (optional)

Enter keywords or a brief description, then press the Search button

Please select an activity (industry code)

Please select an activity (industry description)

Main activity - Question identifier:7

You have indicated that the current main activity of this business or organization is: Are there any other activities that contribute significantly (at least 10%) to this business or organization's revenue?

.

• 1: Yes, there are other activities.
• 2: No, that is the only significant activity.

Main activity - Question identifier:7a

Yes, there are other activities.

Please provide a brief but precise description of this business or organization's secondary activity. e.g., breakfast cereal manufacturing, shoe store, software development

Main activity - Question identifier:8

Approximately what percentage of this business or organization's revenue is generated by each of the following activities? When precise figures are not available, please provide your best estimates.

Main activity - Question identifier:a

#{__NAICS_TITLE_E}

Main activity - Question identifier:b

#{__secondary_NAICS_TITLE_E}

Main activity - Question identifier:c

All other activities.

Total percentage

Reporting period information - Question identifier:1

What are the start and end dates of this business's or organization's most recently completed fiscal year? Note: For this survey, the end date should fall between Start YYYY MM DD and End YYYY+1 MM DD.

Reporting period information - Question identifier:a)

Fiscal year start date Example: YYYY-MM-DD

Reporting period information - Question identifier:b)

Fiscal Year-End date Example: YYYY-MM-DD

Reporting period information - Question identifier:2

What is the reason the reporting period does not cover a full year? Select all that apply.

• 1: Seasonal operations
• 2: New business
• 3: Change of ownership
• 4: Temporarily inactive
• 5: Change of fiscal year
• 6: Ceased operations
• 7: Other reason - specify:
• 8: Other reason - specify: Description

Revenue - Question identifier:1

For the reporting period of MM DD, YYYY to MM DD,YYYY what was this business's revenue from each of the following sources? Notes: -A detailed breakdown may be requested in other sections. -These questions are asked of many different industries. Some questions may not apply to this business. -Refer to the ?Help button for detailed instructions. Please report all amounts in thousands of Canadian dollars.

Revenue - Question identifier:a)

Sales of goods and services Exclude: shipping charges, discounts, sales allowances, returned sales, sales taxes and excise duties and taxes.

Revenue - Question identifier:b)

Rental and leasing

Revenue - Question identifier:c)

Commissions

Revenue - Question identifier:d)

Subsidies Include: grants, donations and fundraising

Revenue - Question identifier:e)

Royalties, rights, licensing and franchise fees

Revenue - Question identifier:f)

Dividends

Revenue - Question identifier:g)

Interest

Revenue - Question identifier:h)

Other revenue - specify:

Total revenue

E-Commerce - Question identifier:2

For the reporting period of MM DD, YYYY to MM, DD YYYY, did this business have any e-commerce revenue?

E-commerce revenue: sale of goods and services conducted over the Internet with or without online payment. Include: all revenue for which an order is received and commitment to purchase is made via the Internet, although payment can be made by other means, such as orders made on web pages, an extranet, mobile devices or Electronic Data Interchange (EDI). Exclude: orders made by telephone, facsimile or e-mail.

• 1: Yes
• 2: No

E-Commerce - Question identifier:3

Of the <####> in total revenue reported, what was the total e-commerce revenue?

If precise figures are not available, please provide your best estimate.

E-Commerce - Question identifier:4

Did this business make sales over the Internet through any of the following methods from YYYY MM DD to YYYY MM DD?
Select all that apply.

Via a mobile app

Via your company website

Via a third-party website

Via Electronic Data Interchange (EDI)

Other methods - specify:

Other methods - specify: (description)

E-Commerce - Question identifier:5

Does this business have any full-time staff dedicated solely to activities related to e-commerce?

• 1: Yes
• 2: No

E-Commerce - Question identifier:6

Why did this business not make sales over the Internet?
Select all that apply.

Goods and services do not lend themselves to online sales

Prefer to maintain current business model

Lack of skilled workers to implement and maintain e-commerce infrastructure

Cost of development is too high

Security concerns

Other reasons - specify:

Other reasons - specify: (description)

Expenses - Question identifier:1

For the reporting period of MM DD, YYYY to MM DD, YYYY, what were this business's expenses for the following items? Notes: -A detailed breakdown may be requested in other sections. -These questions are asked of many different industries. Some questions may not apply to this business. -Please report all amounts in thousands of Canadian dollars. -Refer to the ?Help button for detailed instructions.

Expenses - Question identifier:a)

Purchases Include: raw materials, goods purchased for resale and non-returnable containers. Exclude: change in inventories

Expenses - Question identifier:b) i.

Employment costs and expenses
Include: all employees who were issued a T4 - Salaries, wages and commissions

Expenses - Question identifier:b) ii.

Employment costs and expenses
Include: all employees who were issued a T4 - Employee benefits

Expenses - Question identifier:c)

Subcontracts Exclude: research and development fees.

Expenses - Question identifier:d)

Research and development fees Exclude: in-house research and development

Expenses - Question identifier:e)

Professional and business fees e.g., legal, accounting, consulting, scientific service fees.

Expenses - Question identifier:f)

Energy and water expenses Include: electricity, gas, water, oil, diesel, propane, fuel wood and sewage

Expenses - Question identifier:g)

Office and computer related expenses e.g., office supplies, postage, computer upgrades

Expenses - Question identifier:h)

Telephone, internet and other telecommunication

Expenses - Question identifier:i)

Business taxes, licences and permits e.g., business tax, license fees, property taxes.

Expenses - Question identifier:j)

Royalties, franchise fees and memberships Exclude: Crown royalties.

Expenses - Question identifier:k)

Crown charges (for logging, mining and energy industries only).

Expenses - Question identifier:l)

Rental and leasing Include: land, buildings, equipment, vehicles.

Expenses - Question identifier:m)

Repair and maintenance Include: buildings, equipment, vehicles

Expenses - Question identifier:n)

Amortization and depreciation

Expenses - Question identifier:o)

Insurance

Expenses - Question identifier:p)

Advertising, marketing, promotion, meals and entertainment

Expenses - Question identifier:q)

Travel, meetings and conventions

Expenses - Question identifier:r)

Financial service fees e.g., bank charges, transaction fees

Expenses - Question identifier:s)

Interest expense

Expenses - Question identifier:t)

Bad debt, loan losses, donations, political contributions and inventory writedown

Expenses - Question identifier:u)

All other costs and expenses - specify: Include: intracompany expenses.

Total expenses

Expenses - Question identifier:2

Of the <$###> reported in Subcontracts, please provide the percentage breakdown for the following.

Expenses - Question identifier:i)

From Canadian sources

Expenses - Question identifier:ii.

From sources in other countries

Total breakdown Total should equal 100%

Industry characteristics - Question identifier:1

Is this business a cost centre? A cost centre is a subdivision of an organization with which costs are identified for purposes of managerial control.

• 1: Yes
• 2: No

Industry characteristics - Question identifier:2

The next questions are about the value of goods produced. Are the goods valued at:

.

• 1: Final selling price
• 2: Transfer price
• 3: Other basis of value - specify:

Other basis of value - specify: Description

Industry characteristics - Question identifier:3

What were this business's sales for the following items? Report the sales net of shipping charges, discounts, sales allowances, returned sales, sales taxes, and excise duties and taxes. Please report all amounts in thousands of Canadian dollars.

Industry characteristics - Question identifier:a

Sales of goods manufactured (a detailed product breakdown will be requested in a subsequent section)

Industry characteristics - Question identifier:b

Sales of goods purchased for resale, as is

Industry characteristics - Question identifier:c

Revenue from repair work Include only repair revenue from billing labour, as the materials and products are owned by clients, or by other business units of this company.

Industry characteristics - Question identifier:d

Revenue from manufacturing service fees and/or custom work Include only service revenue from billing labour, as the materials and products are owned by clients, or by other business units of this company.

Industry characteristics - Question identifier:e

Other sales - specify:

Other sales - specify: Description

Total sales of goods and services

Industry characteristics - Question identifier:4

Of the [###] reported in Revenue from manufacturing service fees and/or custom work, please provide the percentage breakdown for the following.

Industry characteristics - Question identifier:a

From Canadian clients

Industry characteristics - Question identifier:b

From clients in other countries

Industry characteristics - Question identifier:5

What were this business's expenses for the following items? Please report all amounts in thousands of Canadian dollars.

Industry characteristics - Question identifier:a

Purchases of raw materials and components (a detailed product breakdown will be requested in a subsequent section)

Industry characteristics - Question identifier:b

Purchases of non-returnable containers and other shipping and packaging materials

Industry characteristics - Question identifier:c

Purchases of goods for resale, as is

Industry characteristics - Question identifier:d

Vehicle fuel expense Include: fuel used to operate any type of vehicle such as sales representatives' cars, delivery trucks and lift trucks.
Exclude: any fuel purchased for power/heat generation

Industry characteristics - Question identifier:6

Did this business purchase goods (raw materials, semi-finished, or finished goods) "off the shelf" outside of Canada and sell them "as-is" in foreign markets (including the U.S.) without altering the goods, and without the goods entering Canada before the sale?

.

• 1: Yes
• 2: No
• 3: Don't know

Provide comments if desired.

Industry characteristics - Question identifier:7

For the reporting period, what were this business' expenses for salaries, wages and commissions? Please report all amounts in thousands of Canadian dollars.

Industry characteristics - Question identifier:a

Direct labour (manufacturing or logging)

Industry characteristics - Question identifier:b

Indirect labour (administrative and selling/operating)

Industry characteristics - Question identifier:8

For the reporting period, what was the average number of people employed?

Industry characteristics - Question identifier:a

Direct labour (manufacturing or logging)

Industry characteristics - Question identifier:b

Indirect labour (administrative and selling/operating)

Industry characteristics - Question identifier:9

What was the value of this business's inventory at the beginning and the end of the reporting period?

Industry characteristics - Question identifier:a

Opening CAN$ '000 Raw materials and components Include: non-returnable containers and other shipping and packaging materials

Industry characteristics - Question identifier:b

Opening CAN$ '000 Goods and work in process

Industry characteristics - Question identifier:c

Opening CAN$ '000 Finished goods manufactured

Industry characteristics - Question identifier:d

Opening CAN$ '000 Goods purchased for resale, as is

Industry characteristics - Question identifier:e

Opening CAN$ '000 Other inventories - specify:

Opening CAN$ '000 Other inventories - specify: Description

Opening CAN$ '000 Total inventories

Industry characteristics - Question identifier:a

Closing CAN$ '000 Raw materials and components Include: non-returnable containers and other shipping and packaging materials

Industry characteristics - Question identifier:b

Closing CAN$ '000 Goods and work in process

Industry characteristics - Question identifier:c

Closing CAN$ '000 Finished goods manufactured

Industry characteristics - Question identifier:d

Closing CAN$ '000 Goods purchased for resale, as is

Industry characteristics - Question identifier:e

Closing CAN$ '000 Other inventories - specify:

Closing CAN$ '000 Total inventories

Industry characteristics - Question identifier:10

On DD MM, YYYY+1, last day of the fiscal year, did this business hold inventories abroad, including inventories in transit to Canada? Include: raw materials, work in process, and finished goods recorded in this business's accounting books, but physically located outside of Canada. Also include goods purchased abroad for resale "as-is" in foreign markets.

.

• 1: Yes
• 2: No
• 3: Don't know

Provide comments if desired.

Industry characteristics - Question identifier:11

What was the approximate value of inventories held abroad at the end of the reporting period? Please report all amounts in thousands of Canadian dollars.

Industry characteristics - Question identifier:12

Is the value reported above included in the [###] thousands of Canadian dollars closing inventories previously reported in question 9 from the inventory section?

• 1: Yes
• 2: No

Details on purchased services - Question identifier:1

For the reporting period YYYY MM DD to YYYY MM DD, this business reported expenses for the following items. Please provide the requested details related to these expenses. Please report all amounts in thousands of Canadian dollars.

Details on purchased services - Question identifier:a

Professional and business fees Legal services

Details on purchased services - Question identifier:b

Professional and business fees Accounting, tax preparation, bookkeeping and payroll services

Details on purchased services - Question identifier:c

Professional and business fees Management, scientific and technical consulting services Include: training

Details on purchased services - Question identifier:d

Professional and business fees Office administrative services

Details on purchased services - Question identifier:e

Professional and business fees Freight transportation arrangements and customs brokering services

Details on purchased services - Question identifier:f

Professional and business fees Brokerage and other insurance related services

Details on purchased services - Question identifier:g

Professional and business fees Security brokerage and securities dealing services

Details on purchased services - Question identifier:h

Professional and business fees Other purchased professional services

Professional and business fees Total expenses for professional and business fees (should be equal to or less than the total from question 1e. reported in expenses section: <####>)

Details on purchased services - Question identifier:a

Office and computer related expenses Data processing, hosting, and related services

Details on purchased services - Question identifier:b

Office and computer related expenses Business support services Include: reproductions, call centres, debt collection

Details on purchased services - Question identifier:c

Office and computer related expenses Other office and computer related purchased services

Office and computer related expenses Total expenses for office and computer related expenses (should be equal to or less than the total from question 1g. reported in the expenses section: <####>)

Details on purchased services - Question identifier:a

Royalties, franchise fees and memberships Rights to non-financial intangible assets

Details on purchased services - Question identifier:b

Royalties, franchise fees and memberships Membership fees or services

Details on purchased services - Question identifier:c

Royalties, franchise fees and memberships Other royalties, franchise fees and memberships

Royalties, franchise fees and memberships Total expenses for royalties, franchise fees and memberships (should be equal to or less than the total from question 1j. reported in expenses section: <####>)

Details on purchased services - Question identifier:a

Rental and leasing Non-residential real estate rental

Details on purchased services - Question identifier:b

Rental and leasing Motor vehicle rental and leasing

Details on purchased services - Question identifier:c

Rental and leasing Computer equipment rental and leasing

Details on purchased services - Question identifier:d

Rental and leasing Office machinery and equipment rental and leasing services Exclude: computer equipment

Details on purchased services - Question identifier:e

Rental and leasing Commercial and industrial machinery and equipment renting and leasing services, without operator Exclude: office equipment

Details on purchased services - Question identifier:f

Rental and leasing Other rental services

Rental and leasing Total expenses for rental and leasing (should be equal to or less than the total from question 1l. reported in expenses section: <####>)

Details on purchased services - Question identifier:a

Repair and maintenance Security services and investigation

Details on purchased services - Question identifier:b

Repair and maintenance Waste management and remediation services

Details on purchased services - Question identifier:c

Repair and maintenance Motor vehicle repair and maintenance services

Details on purchased services - Question identifier:d

Repair and maintenance Other repair and maintenance services

Repair and maintenance Total expenses for repair and maintenance (should be equal to or less than the total from question 1m. reported in expenses section: <####>)

Sales by consumer location - Question identifier:1

What was the breakdown of sales by consumer location? Consumer location is the location where the goods or services will ultimately be used. If ultimate consumer location is not known, the following are acceptable substitutes: -shipping destination -client's billing address -location of this business's retail customers -location of this business's warehouses/distribution centres.

Sales by consumer location - Question identifier:a

Newfoundland and Labrador

Sales by consumer location - Question identifier:b

Prince Edward Island

Sales by consumer location - Question identifier:c

Nova Scotia

Sales by consumer location - Question identifier:d

New Brunswick

Sales by consumer location - Question identifier:e

Quebec

Sales by consumer location - Question identifier:f

Ontario

Sales by consumer location - Question identifier:g

Manitoba

Sales by consumer location - Question identifier:h

Saskatchewan

Sales by consumer location - Question identifier:i

Alberta

Sales by consumer location - Question identifier:j

British Columbia

Sales by consumer location - Question identifier:k

Yukon

Sales by consumer location - Question identifier:l

Northwest Territories

Sales by consumer location - Question identifier:m

Nunavut

Sales by consumer location - Question identifier:n

United States

Sales by consumer location - Question identifier:o

All other countries

Total percentage

Sales of goods manufactured and logging - Question identifier:1

During the reporting period of MM DD, YYYY to MM DD, YYYY, did this business sell the following manufactured goods, logs or wood residue? The total net sales for all products should equal the amount reported for the sales of goods manufactured, logs and wood residue in question 3a. of the Industry characteristics section [####].

Product description

Product code

Was this product sold this reporting period?

• 1: Yes
• 2: No

Quantity sold

Unit of Measure

Value of sales - CAN$ '000

Sales of goods manufactured and logging - Question identifier:2

During the reporting period of MM DD, YYYY to MM DD, YYYY, did this business manufacture and sell any other products?

• 1: Yes
• 2: No

.

How many types of products?

Sales of goods manufactured and logging - Question identifier:3

Please provide a description of the additional product(s) sold, as well as the value of sales.

Description of product

Value of sales - CAN$ '000

Sales of goods manufactured and logging - Question identifier:4

The sum of the sales of goods manufactured (including logs and wood residue) entered in this section is

.

Does this value include shipping charges by common or contract carriers, discounts, sales allowances, returned sales, sales taxes and excise duties and taxes?

• 1: Yes
• 2: No

What is the amount of shipping charges, discounts, sales allowances, returned sales, sales taxes and excise duties and taxes?

Purchases of raw materials and components to be used in the manufacturing or logging process - Question identifier:1

During the reporting period of MM DD, YYYY to MM DD, YYYY, did this business purchase the following raw materials and components to be used in the manufacturing or logging process?

Product description

Product code

Was this raw material or component purchased this reporting period?

• 1: Yes
• 2: No

Quantity Purchased

Unit of Measure

Cost of purchase - CAN$ '000

Purchases of raw materials and components to be used in the manufacturing or logging process - Question identifier:2

During the reporting period of MM DD, YYYY to MM DD, YYYY, did this business purchase any other raw materials or components to be used in the manufacturing or logging process?

• 1: Yes
• 2: No

.

How many types of raw materials and components?

Purchases of raw materials and components to be used in the manufacturing or logging process - Question identifier:3

Please provide a description of the additional material or components, as well as the cost of purchase.

Description of raw material or component

Cost of purchase - CAN$ '000

Details on this business's locations - Question identifier:1

Please verify and correct this location's address if needed.

Operating name:

Address (number and street):

City:

Province, territory:

• 1: Alberta
• 2: British Columbia
• 3: Manitoba
• 4: New Brunswick
• 5: Newfoundland and Labrador
• 6: Northwest Territories
• 7: Nova Scotia
• 8: Nunavut
• 9: Ontario
• 10: Prince Edward Island
• 11: Quebec
• 12: Saskatchewan
• 13: Yukon Territory

Postal code:

Details on this business's locations - Question identifier:2

What was this location's total operating revenue?

Total operating revenue CAN$ '000

Details on this business's locations - Question identifier:3

What were this location's labour expenses? Exclude: benefits

Direct labour (CAN$ '000) For manufacturing or logging only

Indirect labour (CAN$ '000) For administrative, and selling or operating only

Details on this business's locations - Question identifier:4

Was this business location operational for the full year?

• 1: Yes, full-year operation
• 2: No, part-year operation

Details on this business's locations - Question identifier:5

Statistics Canada reviews all feedback. We invite your comments pertaining to this business location.

Details on this business's locations - Question identifier:6

What were this location's operational start and end dates?

Part Year Operation Start Date:

Part Year Operation End Date:

Details on this business's locations - Question identifier:7

What was the reason(s) for part-year operation? Select all that apply.

Seasonal operation

Ceased operations

New location

Temporarily inactive

Change of fiscal year

Moved

Change of ownership

Other reason - specify:

Other reason - specify: Description

Details on this business's locations - Question identifier:8

Were there any other business locations not listed that were operating during the reporting period?

• 1: Yes
• 2: No

.

How many locations?

Details on this business's locations - Question identifier:9

Please provide the requested details for each additional location.

Operating name:

Address (number and street):

City:

Province, territory:

• 1: Alberta
• 2: British Columbia
• 3: Manitoba
• 4: New Brunswick
• 5: Newfoundland and Labrador
• 6: Northwest Territories
• 7: Nova Scotia
• 8: Nunavut
• 9: Ontario
• 10: Prince Edward Island
• 11: Quebec
• 12: Saskatchewan
• 13: Yukon Territory

Postal code:

Details on this business's locations - Question identifier:10

What was this additional location's total operating revenue?

Total operating revenue CAN$ '000

Details on this business's locations - Question identifier:11

What were this additional location's labour expenses? Exclude: benefits

Direct labour (CAN$ '000) For manufacturing or logging only

Indirect labour (CAN$ '000) For administrative, and selling or operating only

Details on this business's locations - Question identifier:12

Was this additional business location operational for the full year?

• 1: Yes
• 2: No

Details on this business's locations - Question identifier:13

Statistics Canada reviews all feedback. We invite your comments pertaining to this business location.

Details on this business's locations - Question identifier:14

What were this additional location's operational start and end dates?

Part Year Operation Start Date:

Part Year Operation End Date:

Details on this business's locations - Question identifier:15

What was the reason(s) for part-year operation for this additional location? Select all that apply.

Seasonal operation

Ceased operations

New location

Temporarily inactive

Change of fiscal year

Moved

Change of ownership

Other reason - specify:

Other reason - specify: Description

Detailed information on energy and water costs or expenses - Question identifier:1

What were this business's energy and water expenses for the following items? Please report all amounts in thousands of Canadian dollars.

Detailed information on energy and water costs or expenses - Question identifier:a

Electricity

Detailed information on energy and water costs or expenses - Question identifier:b

Gasoline

Detailed information on energy and water costs or expenses - Question identifier:c

Light fuel oil

Detailed information on energy and water costs or expenses - Question identifier:d

Heavy fuel oil

Detailed information on energy and water costs or expenses - Question identifier:e

Diesel fuel

Detailed information on energy and water costs or expenses - Question identifier:f

Liquefied petroleum gas e.g., propane, butane

Detailed information on energy and water costs or expenses - Question identifier:g

Natural gas

Detailed information on energy and water costs or expenses - Question identifier:h

Coal

Detailed information on energy and water costs or expenses - Question identifier:i

Water utilities

Detailed information on energy and water costs or expenses - Question identifier:j

Other energy and water expenses - specify: e.g., steam, oxygen, hydrogen

Other energy and water expenses - specify: Description

Total energy and water expenses

Detailed information on energy and water costs or expenses - Question identifier:2

Does this business pay rent?

• 1: Yes
• 2: No

Detailed information on energy and water costs or expenses - Question identifier:3

Are any additional electricity, water or heat expenses, not already reported in question 1, included in the rent?

• 1: Yes
• 2: No

Detailed information on energy and water costs or expenses - Question identifier:4

Which utility is included in the rent? Select all that apply.

Electricity

Water

Heat

Detailed information on energy and water costs or expenses - Question identifier:5

Did this business generate any energy used as a replacement for purchased energy?

• 1: Yes
• 2: No

Detailed information on energy and water costs or expenses - Question identifier:6

Which type of energy was generated? Select all that apply.

Heat

Electricity

Steam

Other type of energy - specify:

Other type of energy - specify: Description

Indicate any changes or events that affected the reported values for this business or organization, compared with the last reporting period. Select all that apply.

• 1: Strike or lock-out
• 2: Exchange rate impact
• 3: Price changes in goods or services sold
• 4: Contracting out
• 5: Organisational change
• 6: Price changes in labour or raw materials
• 7: Natural disaster
• 8: Recession
• 9: Change in product line
• 10: Sold business units
• 11: Expansion
• 12: New/lost contract
• 13: Plant Closures
• 14: Acquisition of business units
• 15: Other changes or events - specify:
• 16: Other changes or events - specify: (description)
• 17: No changes or events

Contact person - Question identifier:1

Who is the best person to contact about this questionnaire?

First name:

Last name:

Title:

Email address:

Telephone number (including area code):

Extension number (if applicable):

Fax number (including area code):

Feedback - Question identifier:1

How long did it take to complete this questionnaire? Include time spent gathering the necessary information.

Hours

Minutes

Feedback - Question identifier:2

We invite your comments about this questionnaire.