Your Full Name: *

Email Address: *

What is your Business Website URL? *

What type of workspace do you have? *
OfficeWarehouseManufacturingOther

Other, please specify:

What is the size of your workspace?

Are you paying for your electricity usage?
YesNo

If yes, how much per month?

Number of workers in the workspace:

Number of work hours (including breaks & overtime) in a typical week:

What type of lightbulbs are in your workspace? (Select more than one if applicable)
IncandescentHalogenFluorescentLED

Are you happy with the current lighting in your workspace?
YesNo

If no, have employees complained about the workspace lighting?
YesNo

If yes, please specify:

1. Are windows or skylights used to take advantage of daylight? *
YesNo

Is this a priority?

Remarks

2. Are workstations arranged near windows or skylights for work requiring strong light? *
YesNo

Is this a priority?

Remarks

3. Are ceiling and walls painted white or in a light colour? *
YesNo

Is this a priority?

Remarks

4. Are multiple light sources used at workstations? *
YesNo

Is this a priority?

Remarks

5. Are lighting fixtures placed at a high position to prevent direct glare? *
YesNo

Is this a priority?

Remarks

6. Are lighting sources placed high to provide evenly distributed general lighting? *
YesNo

Is this a priority?

Remarks

7. Are general and local lighting sources combined to provide necessary light and prevent large contrasts in brightness? *
YesNo

Is this a priority?

Remarks

8. Is each electrical light source on a dimmer to control the amount of light? *
YesNo

Is this a priority?

Remarks

9. How often are blown or are reduced in brightness lightbulbs and tubes replaced? *
YesNo

Is this a priority?

Remarks