ORS 15 1P Establishment work level, and schedule collection form

U.S. Department of Labor Bureau of Labor Statistics

Occupational Requirements Survey

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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:	Sample Number:
Assigned Employment:	Total 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
Refusal
Out of business
Out of scope
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

1^st 2^nd 3^rd 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

1^st 2^nd 3^rd 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

2

ORS Form 15-1P