Form Form F4 – Self-Assessment for Existing Schemes
Part 1 Scheme Identification and Declaration
Q1. SCHEME IDENTIFICATION
Part 1 Scheme Identification and Declaration
Q2. DECLARATION & ATTACHMENTS
Part 2 Scheme Energy Inputs and Outputs
Q3. PERIOD OF OPERATION FOR SELF-ASSESSMENT
Guidance:  See GN14
Part 2 Scheme Energy Inputs and Outputs
Q4. ENERGY INPUTS
Guidance:  See GN12.3
 See GN14.6 and 14.7 and GN29
 For Schemes with TPC<2MWe with no heat only boilers, it is acceptable to provide Annual Totals only
Part 2 Scheme Energy Inputs and Outputs
Q5. POWER OUTPUTS (GENERATED, EXPORTED OR IMPORTED)
Guidance:  See GN15
 See GN15.11
 See GN12
 See GN15.4
 For Schemes with TPC<2MWe with no heat only boilers, it is acceptable to provide Annual Totals only
Part 2 Scheme Energy Inputs and Outputs
Q6. HEAT OUTPUTS FOR ALL SCHEMES
Guidance:  See GN16
 See GN10.20
 See GN12.3
 Details of heat exports should be identified in the appropriate section below
 For Schemes with TPC<2MWe with no heat only boilers, it is acceptable to provide the Annual Total only (based on actual heat monitoring figures)
Part 3 Criteria 1: Power Efficiency
Q7. CHP SCHEME EFFICIENCY
Guidance:  See GN24.2
[report efficiency % to 2 decimal places]
Note: Efficiencies are commonly quoted in terms of % figures, as calculated above, but for all of the calculations that follow, efficiencies must be expressed as decimal fractions, e.g. 40.25% = 0.4025
Part 3 Criteria 1: Power Efficiency
Q8. POWER EFFICIENCY THRESHOLD
Options: YES; NO
Part 3 Criteria 1: Power Efficiency
Q9. QUALIFYING FUEL INPUT (CHP )
Part 4 Criteria 2 Quality Index (QI)
Q10. QUALITY INDEX DEFINITION
Guidance:  See CHPQA Standard (Issues 5 and 6)
Part 4 Criteria 2 Quality Index (QI)
Q11. QUALITY INDEX VALUE
Guidance:  See GN24.11 & 24.12
Part 4 Criteria 2 Quality Index (QI)
Q12. QUALITY INDEX THRESHOLD
Options: YES; NO
Part 5 Calculation of CHP and CHP
Q13. CHP QUALIFYING POWER OUTPUT - WITH NO CONDENSING ST.
Guidance:  See GN26
Part 5 Calculation of CHP and CHP
Q14. CHP QUALIFYING POWER CAPACITY - WITH NO CONDENSING ST.
Guidance:  See GN27
Part 5 Calculation of CHP and CHP
Q15. CHP QUALIFYING POWER OUTPUT - WITH CONDENSING ST.
Guidance:  See GN26 & 28
Part 5 Calculation of CHP and CHP
Q16. CHP QUALIFYING POWER CAPACITY - WITH CONDENSING ST.
Guidance:  See GN27
Part 6 Exports of Electricity and Heat
Q17. ELECTRICITY AND HEAT CUSTOMERS
Options: YES; NO
Part 7: Using CHPQA to Claim Renewable Obligation Certificates (ROCs) or Qualify for Contracts for Difference (CfD) support
Q18. STATEMENT OF INTENTION TO USE CHPQA TO CLAIM ROCS OR QUALIFY FOR CFD SUPPORT
Options: YES; NO
Part 7: Using CHPQA to Claim Renewable Obligation Certificates (ROCs) or Qualify for Contracts for Difference (CfD) support
Q19. QI DEFINITIONS
Part 7: Using CHPQA to Claim Renewable Obligation Certificates (ROCs) or Qualify for Contracts for Difference (CfD) support
Q20. QUALITY INDEX VALUE
Guidance:  See GN24.11 & 24.12
Part 7: Using CHPQA to Claim Renewable Obligation Certificates (ROCs) or Qualify for Contracts for Difference (CfD) support
Q21. ROCS AND CFD QUALITY INDEX CRITERIA
Options: YES; NO
Part 8: ROCs AND CFD CHP calculation (Annual Operation)
Q22. CHP QUALIFYING POWER OUTPUT - WITH NO CONDENSING STEAM TURBINE.
Guidance:  See GN26 & 28
 CHPQPO calculation is based on fuels used, power generated and heat supplied in MWh based on annual data submitted in Part 2. See GN26.
Part 8: ROCs AND CFD CHP calculation (Annual Operation)
Q23. CHP QUALIFYING POWER OUTPUT - WITH CONDENSING STEAM TURBINE.
Guidance:  See GN26 & 28
 CHPQPO calculation is based on fuels used, power generated and heat supplied in MWh based on annual data submitted in Part 2. See GN26.
Part 9: Secretary of State (CHP) Exemption Certificate Application
Q24. SECRETARY OF STATE (CHP) EXEMPTION CERTIFICATE APPLICATION
Options: Please maintain the validity of the Secretary of State (CHP) Exemption Certificate for this CHP Scheme.; Please send me the Secretary of State (CHP) Exemption Certificate for this CHP Scheme.; Please vary the Secretary of State (CHP) Exemption Certificate for this CHP Scheme.; A Secretary of State (CHP) Exemption Certificate is not required
ADDENDUM– PERMISSION TO PROVIDE DATA
Q25. REQUEST FOR ADDITIONAL INFORMATION TO PREPARE STATISTICS FOR EUROSTAT
ADDENDUM– PERMISSION TO PROVIDE DATA
Q26. PERMISSION TO PROVIDE DATA FOR PUBLICATION
Options: YES