Form 15-1P Establishment Collection Form for Private Industry

Occupational Requirements Survey

OMB_ORS_Form_Priv_Form15-1P_2015_0428

ORS - Private Sector

OMB: 1220-0189

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ORS Form 15-1P (2015)


U.S. Department of Labor

Bureau of Labor Statistics


Occupational Requirements Survey


The Bureau of Labor Statistics, its employees, agents, and partner statistical agencies, 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, 31 United States Code §§ 1535/FAR 17.5 of the Economy Act. Your voluntary cooperation is needed to make the results of this survey comprehensive, accurate and timely.


O.M.B. #1220-XX

Expires X/XX/XX

We estimate that it will take an average of 54 minutes to complete this form, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this information. If you have any comments regarding this estimate or any other aspect of this survey, including suggestions for reducing this burden, please send them to the Bureau of Labor Statistics, Office of Compensation and Working Conditions (1220-XXXX), 2 Massachusetts Avenue N.E., Washington, D.C. 20212. You are not required to respond to the collection of information unless it displays a currently valid OMB control number.


ESTABLISHMENT COLLECTION FORM FOR PRIVATE INDUSTRY

(Work level and schedule)


Start Time/End Time:


Address # 1.

Physical Address Personal Visit Address Mailing Address


Schedule Number(#):

Company Name:

Secondary Name (Doing Business As):

Address:

City/State/ZIP:

Address # 2.

Physical Address Personal Visit Address Mailing Address


Company Name:

Secondary Name (Doing Business As):

Address:

City/State/ZIP:


Establishment Officials (Contact List)

# 1: Authorizing Supplying

Title:

Telephone #:

FAX #:

E-mail:

Address: 1, 2, or COC. Mail forms to

# 2: Authorizing Supplying

Title:

Telephone #:

FAX #:

E-mail:

Address: 1, 2, or COC. Mail forms to

# 3: Authorizing Supplying

Title:

Telephone #:

FAX #:

Email:

Address: 1, 2, or COC. Mail forms to



Central Office Clearance (Complete if clearance and/or data obtained from this source)

Clearance obtained: Schedule (data) obtained:

Company Name:

Address:

City/State/ZIP:




Remarks




































COMPANY DATA

Establishment Information (current data) Schedule #:

State:

Collection Panel:

Sample Number:

Assigned Employment:

Total Employment:

PSO Employment:

NAICS:


Establishment Description:

Product Description:



Collection Information

Field Economist:

Method of Collection:

Collection Date:

Payroll Reference Date:



Respondent waived confidentiality Data obtained electronically


Document obtained (Secondary data source)


Written Permission: Yes, No

Name and Title of Official:

Date of Permission:

Permission on file at RO: Yes, No




Status (IDC Wage)

Establishment Status:

Remarks:


Usable



On strike



Vacant



Temporary non response



Refusal



Out of business



Out of scope



Abolished



No matching jobs



Duplicate





SMG Notification


Reason:

Remarks:

Ownership/NAICS change


Part of assigned unit


Collected unit larger than assigned


Employment +/- 20% of assigned


Employment up – business fluctuations


Sampled employment wrong


SMG chose establishment subsample


Overlap (set by system)


Other discrepancy




Remarks












































OCCUPATIONAL REQUIREMENTS SURVEY - Leveling

Schedule Number:




Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:


Non-supervisory Lead Supervisory

Establishment Job Title:


Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTACTS




PHYSICAL ENVIRONMENT





Remarks






















OCCUPATIONAL REQUIREMENTS SURVEY - Leveling

Schedule Number:




Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:


Non-supervisory Lead Supervisory

Establishment Job Title:




Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTACTS




PHYSICAL ENVIRONMENT






Remarks
























OCCUPATIONAL REQUIREMENTS SURVEY - Leveling

Schedule Number:




Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:


Non-supervisory Lead Supervisory

Establishment Job Title:


Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTACTS




PHYSICAL ENVIRONMENT






Remarks




























OCCUPATIONAL REQUIREMENTS SURVEY - Leveling

Schedule Number:




Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:


Non-supervisory Lead Supervisory

Establishment Job Title:


Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTACTS




PHYSICAL ENVIRONMENT






Remarks

























OCCUPATIONAL REQUIREMENTS SURVEY - Leveling

Schedule Number:




Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:


Non-supervisory Lead Supervisory

Establishment Job Title:


Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTACTS




PHYSICAL ENVIRONMENT







Remarks

























OCCUPATIONAL REQUIREMENTS SURVEY - Leveling

Schedule Number:




Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:


Non-supervisory Lead Supervisory

Establishment Job Title:


Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTACTS




PHYSICAL ENVIRONMENT






Remarks

























OCCUPATIONAL REQUIREMENTS SURVEY - Leveling

Schedule Number:




Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:


Non-supervisory Lead Supervisory

Establishment Job Title:


Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTACTS




PHYSICAL ENVIRONMENT






Remarks


























OCCUPATIONAL REQUIREMENTS SURVEY - Leveling

Schedule Number:




Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:


Non-supervisory Lead Supervisory

Establishment Job Title:


Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTRACTS




PHYSICAL ENVIRONMENT






Remarks


























OCCUPATIONAL REQUIREMENTS SURVEY
Base Leveling Supervisor

Schedule Number:




Supervisor

1st 2nd 3rd Line Supervisor/Manager



Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:

Establishment Job Title:






Highest Level Non-Supervisory Subordinate Position _________________________________________________


Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTACTS




PHYSICAL ENVIRONMENT





Remarks
























OCCUPATIONAL REQUIREMENTS SURVEY
Leveling on Duties and Responsibilities of Supervisor

Schedule Number:




Supervisor

1st 2nd 3rd Line Supervisor/Manager



Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:

Establishment Job Title:







Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTACTS




PHYSICAL ENVIRONMENT





Remarks




















OCCUPATIONAL REQUIREMENTS SURVEY
Leveling Summary


Schedule Number:








Leveling Factors


QUOTE 1

QUOTE 2

QUOTE 3

QUOTE 4

QUOTE 5

QUOTE 6

QUOTE 7

QUOTE 8

KNOWLEDGE











JOB CONTROLS AND

COMPLEXITY










CONTACTS











PHYSICAL ENVIRONMENT













Remarks


























OCCUPATIONAL REQUIREMENTS SURVEY -
Work Schedule

Schedule Number:





Quote #

Work Schedule #

Description/occupation

Hours/day

Hours/week

Weeks/year

Type

























































For “Work Schedule #” note also if Alternate work schedule (Only needed for index schedules)








Remarks








































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