DRAFT COPY

Energy Use Questionnaire

Name:

Class:

This short questionnaire will help you to identify how you use energy in your home and
what sources of energy are used.

1 What fuel is used at home :

For heating the house?
For cooking?

..
..

For heating water?

..

2a If your home uses electricity what company provides this service?

________________________________________________________________
2b What is the raw material these companies use? For example, is it coal, oil, gas,
water, nuclear power?
________________________________________________________________
2c If you have wood or coal delivered where is this material sourced from? Where
are the forests or coal pits that provide it?
________________________________________________________________
3 Which of the following appliances do you use at home? How are they powered?
Appliance

Do you use it?

(yes or no)

What source of
energy is used
?

Does this cause

pollution?

Computer
Television
Video/ DVD
Stereo
Camera
Calculator
Dishwasher
Kettle
Cooker
Microwave
134239542.doc

page 1 of 3

DRAFT COPY

Washing
machine/dryer
Hair dryer
Iron
4 How many people live in your household?

5 How many of the following does your household have?

Car(s)

Motor bike(s)

Bicycle(s)

6a What form of transport do you use to get to school each day? What is its source
of power?
Transport

Do you use it?

(Yes or no)

What powers it?

Does this cause

pollution?

By foot
Cycle
Car
Train
Bus
6b Why do you use this form of transport?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
7 When we transport and use fossil fuels we cause pollution. What pollution do we
cause and what effects does it have on your local area?
________________________________________________________________
________________________________________________________________
________________________________________________________________
134239542.doc

page 2 of 3

DRAFT COPY

________________________________________________________________

7 We also have to transport fossil fuels around the world. What pollution does this
make and what effects does this have on the global environment?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

134239542.doc

page 3 of 3