Section I: General Information

 

 Format (xxx xxx xxxx) 

New primary contact for WaterSense 

Email and/or telephone update 

Please update your interests and preferences to receive more specific communications from WaterSense. 

 Please enter a number without commas. 

Yes No 

Yes No 

Section II: Promotional Activities 

Please indicate what types of WaterSense promotional activities you conducted last year and what you plan to implement in 2013. 

 

 

Organization Name * Please select... 6

Contact Name *

Email

Telephone

Contact Update? gfedc

gfedc

If water provider, population served

Is the area you serve currently experiencing water shortages? * nmlkj nmlkj

Do you anticipate that the area you serve will experience water shortages in the next 5 years? * nmlkj nmlkj

2012 2013 

Website promotion with link to WaterSense gfedc gfedc

Coverage on social media outlets (e.g., Facebook, Twitter) gfedc gfedc

Print advertising gfedc gfedc

Television/radio advertising gfedc gfedc

Newsletter or trade journal article gfedc gfedc

Consumer handouts gfedc gfedc

Public signage gfedc gfedc

Exhibit at public fair, conferences, events gfedc gfedc

Bill insert gfedc gfedc

Workshop for consumers gfedc gfedc

Workshop/training for contractors gfedc gfedc

Presentation(s) to schools, community groups, etc. gfedc gfedc

Promotion of WaterSense irrigation partners gfedc gfedc

Recruitment of new WaterSense partners gfedc gfedc

Incentive programs (e.g., tax-free holidays, rebates, giveaways) gfedc gfedc

Promotion of new homes gfedc gfedc

Promotion of We're for Water gfedc gfedc

Promotion of Fix a Leak Week gfedc gfedc

Promotion of Shower Better gfedc gfedc

Other gfedc gfedc

If your organization participated in or hosted WaterSense promotional activities or events, please describe your activities (e.g., 

We're for Water, Fix a Leak Week, WaterSense labeled product demonstration, etc.)

5

6

Did you use any WaterSense marketing materials in 2012 (e.g., bill stuffers, brochures, fact sheets)? Are there any other tools or 

materials you would like to see WaterSense develop in 2013?

5

6

Describe any other ways you promoted or educated the public about WaterSense in 2012.

Page 1 of 3

Promotional - Annual Reporting
 

Add your 2012 activities to our WaterSense in Action Partner Story page so others can learn from your success! 

Section III: WaterSense Program Feedback 

In the interest of serving you better, EPA would like to learn more about your opinions and information needs regarding the WaterSense 

program. Please complete the following section to provide feedback to EPA. 

 

 

 

Yes No 

 

Please go to the awards page for application materials and instructions. Award application materials will be available on the WaterSense 

partner website by February 1. 

 

Section IV: Incentive Programs 

If you offer rebate and incentive programs, please fill out the section below. If not, click "Next Page" at the bottom of the page. 

For each product type below, please provide the type of incentive and quantity issued between January 1, 2012, and December 31, 2012. 

If you have a tracking sheet, feel free to attach it to this form. 

 

5

6

On a scale of 1 to 5 (5 = most valuable), how valuable do you find the WaterSense program? * Please select... 6

How has WaterSense added value? * 5

6

On a scale of 1 to 5 (5 = most valuable), how valuable do you find the WaterSense partner website? * Please select... 6

In the past year, how often have you visited the partner website? * Please select... 6

By completing your annual reporting form, you will be eligible to apply for a 2013 WaterSense Partner of the Year award. 

WaterSense encourages all partners to apply regardless of organization size. Are you planning to apply for an award this year? *

nmlkj nmlkj

Help us improve the awards program by telling us why you're not interested in applying for an award. *

5

6

Please provide suggestions for improving the WaterSense program (e.g., tools/materials, webinar topics, communications, 

Helpline, websites, etc.) *

5

6

Tracking Sheet Upload (Optional) Browse...

Type of Incentive # WaterSense 

Incentives Issued** 

# Non-WaterSense 

Incentives Issued 

# Combined 

(WaterSense and 

Non-WaterSense) 

Incentives Issued 

Other Incentive Type 

Toilets Please select... 6 Please enter a number 

without commas. 

Please enter a number 

without commas. 

Please enter a number 

without commas. 

Bathroom Sink 

Faucets Please select... 6 Please enter a number 

without commas. 

Please enter a number 

without commas. 

Please enter a number 

without commas. 

Faucet 

Accessories Please select... 6 Please enter a number 

without commas. 

Please enter a number 

without commas. 

Please enter a number 

without commas. 

Showerheads Please select... 6 Please enter a number 

without commas. 

Please enter a number 

without commas. 

Please enter a number 

without commas. 

Page 2 of 3
** Products must be independently certified to meet EPA criteria in order to earn the WaterSense label. E.g., not all ≤ 1.28 gpf (high-efficiency) toilets are 

WaterSense labeled, only those tested and certified as such. Please refer to the WaterSense labeled product list at www.epa.gov/watersense.

If you are planning to offer rebates in 2013, please complete our Incentive and Rebate Form to make sure you are listed on the Rebate 

Finder on the WaterSense website. 

Section IV: Incentive Programs Continued 

For each type of product below, please provide the type of incentive and quantity issued between January 1, 2012, and December 31, 

2012. If you have a tracking sheet, feel free to attach it to the previous page. 

On the following page, you will be asked to review your responses. You must select "confirm" at the bottom of the following page to 

submit your Annual Reporting Form to WaterSense. 

Please note, you may need to try different printer settings or print as a PDF to print the full report for your records. We apologize for any 

inconvenience. 

 

Need assistance with this form? 

Flushing 

Urinals Please select... 6

Please enter a number 

without commas. 

Please enter a number 

without commas. 

Please enter a number 

without commas. 

Weather-Based 

Irrigation 

Controllers 

Please select... 6 Please enter a number 

without commas. 

Please enter a number 

without commas. 

Please enter a number 

without commas. 

Irrigation 

Professionals Please select... 6 Please enter a number 

without commas. 

Please enter a number 

without commas. 

Please enter a number 

without commas. 

Product Type Incentive Type # Non-WaterSense 

Incentives Issued Other Incentive Type 

Other Please select... 6 Please enter a number 

without commas. 

Other Please select... 6 Please enter a number 

without commas. 

Other Please select... 6 Please enter a number 

without commas. 

Other Please select... 6 Please enter a number 

without commas. 

Other Please select... 6 Please enter a number 

without commas. 

Other Please select... 6 Please enter a number 

without commas. 

Add 

more 

products

Next Page

Page 3 of 3