October 2012
B-3
Appendix B: Sample Worksheets for Water Management Planning
Table B-1. BuildingWater SurveyWorksheet
BuildingWater Survey
Surveyed by:
Date:
General Information
Name of Building:
Address:
Building Contact
Phone:
Building Dimensions:
Width:
Length:
Building wastewater is currently:
o
Treated on site
o
Connected to city water system
o
Other
Is recycled water currently used in any of the
following areas?
o
Toilets
o
Urinals
o
Cooling Towers
o
Irrigation
Number of Floors (height):
Building Occupancy Data
Average Number of Occupants:
Number of Women:
Number of Men:
Occupancy Schedule
Weekdays
From
a.m.
To
p.m.
Saturdays
From
a.m.
To
p.m.
Sundays
From
a.m.
To
p.m.
Holidays
From
a.m.
To
p.m.
