BLS OES Green Jobs BLS OES Green Jobs Fax Form - Panel 5

U .S. Department of Labor, Bureau of Labor Statistics

Green Technologies and Practices

Fax Response Form
Send to (614) 220-8845

Employers selected for the BLS Green Technologies and Practices Survey are requested to respond within 15 days.

If you have questions please contact us at 1-800-341-3660.

Section 1: Establishment information

105 - 12345678901234567890 Establishment ID Number (from front of survey form)

Company Name and Report For (from front of survey form) Today’s Date

Contact Name and Title (please print) Telephone Number (ext) Fax Number

( ) - ( ) -

A . Enter the total number of employees at this location as of May 12, 2011.

B. Describe your main products and services.

Section 2: Green technologies and practices

C. Which of the following green technologies and practices does your business use?

• Column A: Check yes, if this technology or practice was used during the pay period including May 12, 2011.

• Column B: Check yes, if you had employees on your payroll spend any time involved in this technology or practice or training other employees at the establishment (exclude contract employees and consultants).

Column A

Column B

Item

Type of Green Activity

Did your business…?

Did any of your employees spend time on this?

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:

Wind Biomass Geothermal Solar

Ocean Hydropower Landfill gas Municipal solid waste

□Yes

□No

□Does Not Apply

□ Yes

□ No

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

• A LEED certified building

• Energy efficient lighting

• Programmable thermostats

• Cogeneration (combined heat and power)

• Energy efficient manufacturing equipment

□Yes

□No

□Does Not Apply

□ Yes

□ No

Column A

Column B

Item

Type of Green Activity

Did your business…?

Did any of your employees spend time on this?

Greenhouse gas 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.

Practices include but are not limited to:

• Purchase and use of carbon offsets

• Promotion and/or subsidy of green forms of transportation for employees such as carpools, fuel efficient vehicles, cycling, or mass transit

• Implementation of a telework program for employees

□Yes

□No

□Does Not Apply

□ 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:

Carbon monoxide Sulfur dioxide Chlorofluorocarbons(CFCs) Nitrogen oxides Chlorinated hydrocarbons

Heavy metals Herbicides Pesticides Radioactive contamination

□Yes

□No

□Does Not Apply

□ Yes

□ No

Recycling, reuse, and natural resource 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:

Collecting and reusing or recycling waste Managing wastewater

Composting solid waste Remanufacturing

□Yes

□No

□Does Not Apply

□ Yes

□ No

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 practices

□Yes

□No

□Does Not Apply

□ Yes

□ No

Other technologies or practices. Please explain below.

7

X Yes

□ Yes

□ No

D . How many employees spent more than half of their time using the green technologies or practices at your establishment for which you checked yes in Column B?

• If the number of employees entered is greater than zero please complete Section 3 (next page).

• Otherwise, please fax this form to (614) 220-8845. Thank you.

Section 3: Occupations and wages of green employees

E. What are the occupations and wages of the employees who spent more than half of their time using green technologies or practices?

• Provide a job title, brief description of duties, and the annual salary or hourly wage in the space provided.

• Report part-time employees at their hourly rate.

• If you need more space, please copy this page and fax with the completed report.

NUMBER OF EMPLOYEES IN SELECTED WAGE RANGES

(Report Part-time Workers According to an Hourly Rate)

A

B

C

D

E

F

G

H

I

J

K

L

T

Hourly

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

Total

Annual 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

Example:

Hydrologists -

A

B

C

D

E

F

G

H

I

J

K

L

T

Research water usage and implement wastewater treatment plans.

2

1

3

Job Title: Job Description:

Job Title: Job Description:

Job Title: Job Description:

Job Title: Job Description:

Job Title: Job Description:

Thank you. Please fax this report to: (614) 220-8845

OMB No. 1220-0182

Approval expires 12-31-2011

BLS-0182 FAX