Energy Outreach in Rural Communities

Energy Outreach in Rural Communities is a project delivered by Changeworks and funded by Ecotricity. It is designed to particularly help people who are in or at risk of fuel poverty in rural communities to access energy advice.

We are going to ask you some questions to find out what you’re interested in and how we can best help you today. We will be able to give some information today but we may need to follow-up if you need more in-depth advice and information.

First, we will find out what you need help with and then ask some contact details and extra information that our funders want us to report on.

So, what are you most interested in finding out more about?

Support with fuel debt and your energy bills?
Reducing energy use at home?
Making your home warmer and more efficient?
Renewable technologies?
Smart meters?
Anything else?

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Source

Privacy Notice

To be completed by the participant (or on behalf of the participant):

We wish to gather your contact details so that we can keep in touch with further information and any referrals you have requested, gather feedback and also provide anonymised reporting and evaluation of the project to our funders.

Privacy Notice and Consent

Changeworks will process your personal data to contact you regarding the Energy Outreach in Rural Communities project. We will share anonymised data for reporting purposes with the project funder, Ecotricity. If you have requested referral to the Small Measures Pack Referral Scheme, we will use your data to verify eligibility, process and fulfil your order and create anonymised reports on the uptake of the packs. This project is expected to run until 31st March 2024 and your personal information will be held six months after the project end, to allow for monitoring and evaluation. After this it will be anonymised.

For more information about how Changeworks handles personal data, please see our privacy policy on our website.

This data is being collected with your consent. You can withdraw your consent at any time by contacting us at asklcc@changeworks.org.uk

We will also ask about your health to ensure we help you access any funding/referrals you may be eligible for, to ensure our project is reaching the appropriate audience and for anonymised reporting purposes. This information will be held for six months after the project end. After this, it will be anonymised.

Communication Preferences

How do you want to be contacted in the future?

To provide the additional information/referrals you have requested and collect information on your progress, we need to be able to contact you. This may also involve a follow-up questionnaire after the project end.

Can Changeworks contact you in the future?(Required)

Yes

No

Please tick your preferred methods of contact – note that we may contact you via either channel if required:(Required)

Email

Phone

When is the best time to call you?(Required)

Morning

Afternoon

Evening

Personal Information

Which event/group were you attending when you completed this form?(Required)

How did you hear about this event?(Required)

Do you find your home hard to heat?(Required)

Yes

No

Do you worry about energy bills?(Required)

Yes

No

Are you in fuel debt or have had your fuel disconnected?(Required)

Yes

No

Household Information

Please read the following statements and confirm if one of them applies to you and your household:

My energy bills are higher than 10% of my income (excluding any benefits)
I struggle to afford daily life expenditures because of energy costs

Are either of the statements true for your household?(Required)

Yes

No

Does one or more of the following relate to you or other people in your household?(Required)

Do you live in a rural area?(Required)

Yes

No

Is you property off mains gas?(Required)

Yes

No

For the property where you live, which of the following are you?(Required)

Owner occupier

Local Authority tenant

Housing association tenant

Private tenant

Other

How many adults and children live in your household?(Required)

Please tick below if you would prefer not to say

I would prefer not to provide the number of adults and children in my household

How old is your heating system?(Required)

Over 10 years old

Under 10 years old

Do not know

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Is the oldest person in the household aged 16-24 years old?(Required)

Yes

No

Don’t know

Prefer not to say

Is your energy supplier Ecotricity?(Required)

Yes

No

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Who is your energy supplier?(Required)

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Other Energy Supplier(Required)

Reducing energy use at home

What will you do to help reduce energy use at home?

	Going to try this
Wash clothes at 30 degrees
Line dry your clothes outside instead of using a tumble dryer
Avoid standby and turn off appliances / TV / computers when not in use
Only fill the kettle up with as much water as you need
Turn off your lights when you’re not in the room or don’t need them on
Replacing all your lighting with LEDs will cut your lighting bill by around 50%
Choosing an A-rated fridge freezer over an F-rated model could save you money and energy
Choose a laptop over a desktop
Turn down your heating thermostat by one degree
Reduce your shower time by one minute

Further Support

We may also offer to pass your contact information onto other services, who can provide additional advice and support.

Home Energy Scotland is funded by the Scottish Government and managed by the Energy Saving Trust. An advisor from Home Energy Scotland can advise on saving energy, reducing fuel bills and keeping warm, and assess for any extra support that may be available.

Our Affordable Warmth Advisors can support you to keep your home affordably warm and dry, understand energy bills and manage energy debt.

If you would like to be referred for further support and agree for Changeworks to share your contact details with them for this purpose only please indicate below:

Home Energy Scotland:(Required)

Yes

No

Affordable Warmth Services (if it is available in your area):(Required)

Yes

No

Please provide any additional information to help with referrals/follow ups below:

Small Measures Pack Referral Scheme

The Small Measures Pack Referral Scheme will provide small energy efficiency measures to individuals living in Scotland who meet the eligibility criteria and where the items will be used in the main place of residence.

The measures in the pack include reflective radiator panels, LED lightbulbs, and draughtproofing strips.

Packs are limited and will be allocated on a first come first served basis.

For more information on how GTI Direct handles personal data, please see their privacy policy on their website.

If you are interested in this, we can refer you today. We will just need a few details from you so we can arrange delivery. We will send your order to the distribution company GTI Direct for processing and delivery. GTI Direct will send the packs with tracked Royal Mail delivery.

Simple instructions on how to use the items will be included in your pack.

If you would like to be referred for a Small Measures Pack and agree for Changeworks to share your contact details with GTI Direct for this purpose only please indicate below:(Required)

Yes

No

Do you intend to use these measures in your own home:(Required)

Yes

No

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	0	1	2	3	4+
Children under 5
Children aged 5-16
Adults aged 17-64
Adults aged 65-74
Adults aged 75+

Energy Outreach in Rural Communities