BLS OES Green Jobs BLS OES Green Jobs Form

1 1/18/2010-v10

Green Jobs Survey

01-0123456789

O.M.B. No. 1220−xxxx

Expires Month Day Year

• If you need help completing this form, please send an email to xxxxxxxxx@xxx.xxx, or call (xxx)-xxx-xxxx.

• Please complete and return this form within 15 days in the envelope provided.

H

1

as the address of your establishment’s physical location changed? Please provide information only for the location below. If the address shown below is no longer correct, please provide corrections in the space provided.

ATTN:

Enter address corrections

here

XYZ ADVISORS

4TH FLOOR

1310 SILVER STREET

SOMECITY WD 12345-6789

W

2

hat was the total employment of this establishment as of [month] 12, 2010?

Include:	Do Not Include:
Full- or part-time paid workers	Owners, proprietors, and partners of unincorporated firms
W Enter total employment here orkers on paid leave	Unpaid family workers
W orkers assigned temporarily to other units	Workers on unpaid leave
Incorporated firms - paid owners, officers, and staff	Workers not covered by unemployment insurance Contractors and temporary agency employees not on your payroll

What are your main products or services?

3

Our records show that your main products or services are related to those listed below. If they are not, please list your main products or services in the space provided and continue with the rest of the survey.

Enter corrections here

Renting consumer electronics equipment and appliances,

such as televisions, stereos, and refrigerators. Included in this

i ndustry are appliance rental centers.

Confidentiality Statement. The Bureau of Labor Statistics, its employees and agents, will use the information you provide for statistical purposes only and will hold the information in confidence to the full extent permitted by law. In accordance with the Confidential Information Protection and Statistical Efficiency Act of 2002 (Title 5 of Public Law 107-347) and other applicable Federal laws, your responses will not be disclosed in identifiable form without your informed consent. This report is authorized by law 29 U.S.C. 2. Paperwork Reduction Act Statement. Your voluntary cooperation is needed to make the results of this survey comprehensive, accurate, and timely. We estimate that completing this form will take an average of 20 minutes. This estimate takes into account time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information. If you have any comments regarding this survey, including suggestions for reducing the burden, send them to the Bureau of Labor Statistics, Office of Occupational Employment Statistics, Paperwork Reduction Project, 2 Massachusetts Avenue, N.E., Room 2135, Washington, DC 20212. The OMB control number for this voluntary survey is 1220-NEW and expires on month day, year. Without a currently valid number BLS would not be able to conduct this survey.

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4

hat are your establishment’s green technologies and practices?

Column A:

Please indicate in Column A whether this establishment has actively used the type of green technology or practice listed during the pay period including {month} 12, 2010.

Column B:

For any green technologies or practices used during that same pay period at this establishment, please indicate whether there were any employees at this establishment who spent any of their time involved in:

• researching, developing, maintaining, using or installing technologies or practices to lessen the environmental impact of their establishment, or

• training the establishment’s workers in these technologies or practices.

Please include employees on the establishment’s payroll. Do not include contract employees or consultants when completing Column B. The types of employees to include are listed in Question 2 on Page 1.

			Column A	Column B
Item	Type of green activity		Does your establishment …?	Are there any employees on your payroll who …?
	Energy from Renewable Sources and Energy Efficiency
1	Generate electricity, heat, or fuel from renewable sources primarily for use within your establishment? Energy sources include:		 Yes  No	 Yes  No
	Wind Biomass Geothermal Solar	Ocean Hydropower Landfill gas Municipal solid waste
2	Use technologies or practices to improve energy efficiency within your establishment? Practices include but are not limited to the purchase and use of: Energy Star rated appliances Compact fluorescent lights Motion detection lighting Programmable thermostats Cogeneration (combined heat and power)		 Yes  No	 Yes  No

				Column A	Column B
Item	Type of green activity			Does your establishment …?	Are there any employees on your payroll who …?
	Greenhouse Gas Reduction and Pollution Reduction & Removal
3	Use technologies or practices in your operations to reduce greenhouse gas emissions through methods other than those listed in Items 1 and 2 above (renewable energy generation and energy efficiency)? Practices include but are not limited to: Purchase and use of carbon offsets Promotion and/or subsidy of green forms of transportation for employees Implementation of a telework program for employees			 Yes  No	 Yes  No
4	Use practices to either reduce the creation or release of pollutants or toxic compounds as a result of operations, or to remove pollutants or hazardous waste from the environment? Pollutants include but are not limited to:			 Yes  No	 Yes  No
	Carbon monoxide Sulfur dioxide Chlorofluorocarbons (CFCs) Nitrogen oxides Chlorinated hydrocarbons		Heavy metals Herbicides Pesticides Radioactive contamination
	Recycling & Reuse, and Natural Resources Conservation
5	Use technologies or practices to reduce or eliminate the creation of waste materials as a result of your operations? Practices include but are not limited to:			 Yes  No	 Yes  No
	Collecting waste Reusing Managing wastewater	Recycling Composting solid waste Remanufacturing
				Column A	Column B
Item	Type of green activity			Does your establishment …?	Are there any employees on your payroll who …?
6	Use technologies or practices in your operations to conserve natural resources? Please do not include using recycled inputs in your production processes. Practices include, but are not limited to: Managing land resources Managing storm water Conserving soil, water, or wildlife Implementing organic agriculture or sustainable forestry			 Yes  No	 Yes  No
	Other technologies or practices not included previously. Please explain.
7				Yes	 Yes  No
8				Yes	 Yes  No

If you answered ‘no’ for all items in Column B, please enter a zero in Question 5.

H

5

ow many employees spent more than half of their time engaged in green activities at your establishment?

• P

  
  

  Enter number of green employees

  lease provide the total number of employees that spent more than half of their time in green activities in the pay period including {month} 12, 2010.

• Please count employees only once, even if they are included in Column B more than once.

• Please do not include contractors or consultants working at your establishment that are not on your establishment’s payroll.

• If no employees spent more than half of their time on green activities enter zero.

W

6

hat are the occupations and wages of employees engaged in green activities at your establishment?

Complete for employees who spent more than half of their time in green activities in Question 5. Please provide a job title, brief description of duties, and the number of workers by wage category in the space provided. Report part-time employees at their hourly rate.																			A									B								C									D												E													F							G					H							I								J									K							L							Total
Job Title																			under 9.25									$9.25 - 11.49								$11.50 - 14.49									$14.50 - 18.24												$18.25 - 22.74													$22.75 - 28.74							$28.75 - 35.99					$36.00 - 45.24							$45.25 - 56.99								$57.00 - 71.49									$71.50 - 89.99							$90.00 and over
Hourly Brief description of job duties
Salary																			under $19,240									$19,240 - 23,919								$23,920 - 30,159									$30,160 - 37,959												$37,960 - 47,319													$47,320 - 59,799							$59,800 - 74,879					$74,880 - 94,119							$94,120 - 118,559								$118,560 – 148,719									$148,720 – 187,199							$187,200 and over
Sustainability Officer
Implements and monitors corporate sustainability program.																																																																																		1																																						1
																		A							B									C									D											E												F								G						H							I							J											K							L						Total
Job Title																		under 9.25							$9.25 - 11.49									$11.50 - 14.49									$14.50 - 18.24											$18.25 - 22.74												$22.75 - 28.74								$28.75 - 35.99						$36.00 - 45.24							$45.25 - 56.99							$57.00 - 71.49											$71.50 - 89.99							$90.00 and over
Hourly Brief description of job duties
Salary																		under $19,240							$19,240 - 23,919									$23,920 - 30,159									$30,160 - 37,959											$37,960 - 47,319												$47,320 - 59,799								$59,800 - 74,879						$74,880 - 94,119							$94,120 - 118,559							$118,560 – 148,719											$148,720 – 187,199							$187,200 and over

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7

hat is your contact information? For the person or persons who completed this form.

Check if contact information is the same

For Occupation and Wage Information: For Green Activity Information:

Contact Name: _________________________________

E-Mail: ___________________________________________

Department:_______________________________________

Job Title:__________________________________________

Business Website: __________________________________

Phone number: (_______) __________ - ________________

Contact Name: _________________________________

E-Mail: ___________________________________________

Department:_______________________________________

Job Title:__________________________________________

Business Website: __________________________________

Phone number: (_______) __________ - ________________

Thank you for completing this survey.

Please return this form in the enclosed envelope to:

Strategic Research Group

995 Goodale Blvd.

Columbus, OH 43212