ENERGY STAR® Challenge for Industry Registration Form

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OMB Control No. 2060-0347

ENERGY STAR® Challenge for Industry Registration

Form

Please complete this form to take the ENERGY STAR Challenge for Industry by pledging to 

improve the energy efficiency of your manufacturing site by 10 percent within 5 years from your 

baseline year. For information on requirements, supporting tools, and recognition, please visit 

www.energystar.gov/industrychallenge.

* Required

Site Information

Company Name *

Site Name * 

Site Address * 

Site City *

Site State (and/or District, Province, etc.) *

Site Zip Code or Postal Code *

Site Country *

Industry Description *

Please provide a short description of your business. Example: Our company manufactures 

widgets.
ENERGY STAR® Challenge for Industry Registration Form

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OMB Control No. 2060-0347

Products Produced at This Site *

Number of Employees at This Site (Optional)

Contact Information

Contact Name * 

Contact Title * 

Contact Address * 

Contact City *

Contact State (and/or District, Province, etc.) *

Contact Zip Code or Postal Code *
ENERGY STAR® Challenge for Industry Registration Form

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OMB Control No. 2060-0347

Contact Country * 

Contact Phone * 

Contact Email *

Baseline, Tracking, and Goals

Energy Intensity Metric *

Explanation of Energy Intensity Metric Selection *

Please include a brief explanation of why the selected metric is appropriate. Example: Our site 

produces a variety of widget types which we track by weight.

Baseline Year *

Please select the ending month of your 12-month baseline period. The baseline must begin in the 

year prior to signing up for the Challenge. The baseline can be based on the immediate past year 

(e.g., a site signing up in April 2012 could set their baseline as January 1, 2011 - December 31,

2011), or another consecutive 12-month period such as the most recent 12 months (e.g., a site 

signing up in April 2012 could set their baseline as April 1, 2011 - March 31, 2012), or the site's 

most recent fiscal year.

December 2011

Baseline Energy Intensity *

Baseline Total Energy (Optional)
ENERGY STAR® Challenge for Industry Registration Form

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OMB Control No. 2060-0347

(E.g., Total Source Energy in BTUs)

10% Reduction Target *

(E.g. Your target annual energy intensity)

Tracking System *

Please check the primary tracking system(s) you plan to use.

Internal System

Portfolio Manager

ENERGY STAR Energy Tracking Tool (ETT)

ENERGY STAR Plant Energy Performance Indicator (EPI)

Energy Tracking Plan *

Please check the appropriate response(s).

We have existing policies and procedures for managing energy data. 

We have established a Challenge for Industry Energy Tracking Plan.

Additional Information

Is your company an ENERGY STAR Industrial Partner? *

Yes

No

Is this the first time this site has signed up for the Challenge for Industry? If no, please 

indicate how many times this site has signed up in the "Other" text box below. *

Yes

No

Other:

How did you learn of the ENERGY STAR Challenge for Industry? (Optional)

If you are paricipating as part of a promoter organization's initiative (e.g., industry association, 

utility), please name that organization below.
ENERGY STAR® Challenge for Industry Registration Form

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OMB Control No. 2060-0347

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Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent 

burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental 

Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any 

correspondence. Do not send the completed form to this address.

EPA Form 5900-263