Personal Carbon Footprint Baseline Assessment

Personal Carbon Footprint Baseline Assessment — Form Fields

This personal template includes 9 fields. Assess your estimated personal carbon footprint across transportation, diet, and energy use. Free to customize and use on ZenBuild.

• Your Name (text, required)
• Email (email, required)
• Primary Transportation Mode (dropdown selection, required) — options: Personal Car (Gas), Personal Car (Hybrid), Electric Vehicle, Public Transit, Bicycle/Walk, Mix
• Miles Driven Per Year (if car) (number, optional)
• Flight Frequency (dropdown selection, required) — options: Never, 1-2 Short Flights, 1-2 Long Flights, 3-5 Flights, 6+ Flights Per Year
• Diet Type (dropdown selection, required) — options: Heavy Meat Eater, Average Omnivore, Flexitarian, Vegetarian, Vegan
• Home Energy Source (dropdown selection, required) — options: Grid Electricity (Coal/Gas Mix), Partial Renewables, 100% Renewable, Solar Panels, Gas + Electric
• Monthly Electric Bill ($) (number, optional)
• Low-Carbon Habits Practiced (checkboxes, optional) — options: Compost, Minimal Plastic, Buy Secondhand, Meatless Days, LED Lighting, Line Dry Laundry