Commitment Actions Form

Family Action Form

From the list below, please select as many Actions as your family will commit to
for at least the next year to reduce your Energy Footprint (sample Family Action Paybacks)
For support or questions contact Young Energy staff.

	FIRST NAME LAST NAME			PHONE NUMBER
	COMMITMENT ACTIONS (Sample goals provided in red, customize your own in the Family Goals box)	YES	NO	Family Goals
1	Improve your vehicle's fuel economy by (4mpg or 1 km/litre) by replacing you current vehicle with a more fuel efficient vehicle			either mpg or km/litre
2	Reduce KM you drive by:
a	- taking transit to work/school (20 km/day x 5 days/week x 48 weeks/year)			km/day x days/wk x wks/yr
b	- live close to where you buy groceries, go to school, work and play			km we save per year
c	- cycling, or walking to buy groceries, go to school, work and play			km we save per year
3	Stop your car engine rather than idling during traffic for 5 minutes per day			minutes per day
4	Driving less aggressively saves up to 10% of fuel costs by actions such as reducing speed, coasting up to intersections and others
5	Change high use (4hrs/day) 100W light bulbs to Compact Fluorescent bulbs			we will replace 100W light bulbs
6	Install one low flow shower head			we will install shower heads
7	Reduce Thermostat temperature at night by 4 degrees C			degrees C
8	Reduce Thermostat temperature all the time by 2 degree C			degrees C
9	Eat one extra meatless meal per week (if vegetarian select "No")
10	Install a new high efficiency furnace
11	Install a new high efficiency hot water tank
12	Replace a 10 year old clothes washer with a front load Energy Star model
13	Choose your vacation local and nearby rather than flying
14	Reduce 1 Return Flight per year per family member (1 flight per 2 family members to reduce 1500 km/year)			flight(s) per family member(s) to reduce km/year
15	Change medium use (2hrs/day) 100W light bulb to Compact Fluorescent bulb			number of light bulbs
16	Lower the temperature on your hot water tank (ex. from 60 to 50 degrees C)			will lower by degrees C
17	Use cold water instead of hot water when washing clothes (100 times per year)			times per year
18	Air dry your clothes once per week (50 times per year)			times per year
19	Set Thermostat back to 5 degrees C when you go for vacation in the winter			weeks per year at 5 degrees C
20	Install a new mid efficiency furnace
21	Install a new mid efficiency hot water tank
22	Replace a 10 year old refrigerator with new Energy Star model
23	Replace a 10 year old clothes dryer with new Energy Star model
24	Replace a 10 year old dishwasher with new Energy Star model
25	Replace a 10 year old freezer with new Energy Star model
26	Install weather stripping on doors and caulk windows (older houses only)
27	Purchase a new flat screen monitor for your computer
28	Put a 2 litre plastic bottle filled with water in your toilet tank (4 flushes/day)			saves water
29	Use the energy saving features on your dishwasher
30	Unplug all black boxes/TV's in your house or use a power bar to switch off