ORS 15 1P Establishment Collection Form for Private Industry Work

U.S. Department of Labor
Bureau of Labor Statistics

Occupational Requirements
Survey

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agencies, will use the information you provide for statistical purposes only and will
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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. #1220-0189

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
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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

Telephone #:
FAX #:
# 2:
Authorizing
Telephone #:
FAX #:

Supplying

# 3:
Authorizing
Telephone #:
FAX #:

Supplying

ORS Form 15-1P

Title:

Supplying
E-mail:
Address:

1,

2, or

COC.
Title:

Mail forms to

E-mail:
Address:

1,

2, or

COC.
Title:

Mail forms to

1,

2, or

COC.

Mail forms to

Email:
Address:
1

August 2023

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

Schedule (data) obtained:

Address:
City/State/ZIP:

Remarks

ORS Form 15-1P

2

August 2023

COMPANY DATA

Establishment Information (current data)
State:
Assigned Employment:
NAICS:
Establishment Description:

Schedule #:

Sample Number:
Total Employment:

Product Description:

Collection Information
Field Economist:
Collection Date:

Method of Collection:
Payroll Reference Date:

Data obtained electronically
Written Permission:
Date of Permission:

Yes,

No

Status (IDC Wage)

Establishment Status:
Usable
Refusal
Out of business
Out of scope
No matching jobs
Duplicate

SMG Notification

Reason:
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

ORS Form 15-1P

Document obtained (Secondary data source)
Name and Title of Official:
Permission on file at RO:

Yes,

No

Remarks:

Remarks:

3

August 2023

Remarks

ORS Form 15-1P

4

August 2023

OCCUPATIONAL REQUIREMENTS SURVEY - Leveling
Quote:

Occupation:

Establishment Grade:

SOC:

Establishment Rate Range:
Non-supervisory

Schedule Number:

Lead

Factor

KNOWLEDGE

Establishment Job Title:
Supervisory
Level

Education, experience, other comments

JOB CONTROLS AND
COMPLEXITY
CONTACTS
PHYSICAL ENVIRONMENT

Remarks

ORS Form 15-1P

5

August 2023

OCCUPATIONAL REQUIREMENTS SURVEY - Leveling
Quote:

Occupation:

Establishment Grade:

SOC:

Establishment Rate Range:
Non-supervisory

Schedule Number:

Lead

Factor

KNOWLEDGE

Establishment Job Title:
Supervisory
Level

Education, experience, other comments

JOB CONTROLS AND
COMPLEXITY
CONTACTS
PHYSICAL ENVIRONMENT

Remarks

ORS Form 15-1P

6

August 2023

OCCUPATIONAL REQUIREMENTS SURVEY - Leveling
Quote:

Occupation:

Establishment Grade:

SOC:

Establishment Rate Range:
Non-supervisory

Schedule Number:

Lead

Factor

KNOWLEDGE

Establishment Job Title:
Supervisory
Level

Education, experience, other comments

JOB CONTROLS AND
COMPLEXITY
CONTACTS
PHYSICAL ENVIRONMENT

Remarks

ORS Form 15-1P

7

August 2023

OCCUPATIONAL REQUIREMENTS SURVEY - Leveling
Quote:

Occupation:

Establishment Grade:

SOC:

Establishment Rate Range:
Non-supervisory

Schedule Number:

Lead

Factor

KNOWLEDGE

Establishment Job Title:
Supervisory
Level

Education, experience, other comments

JOB CONTROLS AND
COMPLEXITY
CONTACTS
PHYSICAL ENVIRONMENT

Remarks

ORS Form 15-1P

8

August 2023

OCCUPATIONAL REQUIREMENTS SURVEY - Leveling
Quote:

Occupation:

Establishment Grade:

SOC:

Establishment Rate Range:
Non-supervisory

Schedule Number:

Lead

Factor

KNOWLEDGE

Establishment Job Title:
Supervisory
Level

Education, experience, other comments

JOB CONTROLS AND
COMPLEXITY
CONTACTS
PHYSICAL ENVIRONMENT

Remarks

ORS Form 15-1P

9

August 2023

OCCUPATIONAL REQUIREMENTS SURVEY - Leveling
Quote:

Occupation:

Establishment Grade:

SOC:

Establishment Rate Range:
Non-supervisory

Schedule Number:

Lead

Factor

KNOWLEDGE

Establishment Job Title:
Supervisory
Level

Education, experience, other comments

JOB CONTROLS AND
COMPLEXITY
CONTACTS
PHYSICAL ENVIRONMENT

Remarks

ORS Form 15-1P

10

August 2023

OCCUPATIONAL REQUIREMENTS SURVEY - Leveling
Quote:

Occupation:

Establishment Grade:

SOC:

Establishment Rate Range:
Non-supervisory

Schedule Number:

Lead

Factor

KNOWLEDGE

Establishment Job Title:
Supervisory
Level

Education, experience, other comments

JOB CONTROLS AND
COMPLEXITY
CONTACTS
PHYSICAL ENVIRONMENT

Remarks

ORS Form 15-1P

11

August 2023

OCCUPATIONAL REQUIREMENTS SURVEY - Leveling
Quote:

Occupation:

Establishment Grade:

SOC:

Establishment Rate Range:
Non-supervisory

Schedule Number:

Lead

Factor

KNOWLEDGE

Establishment Job Title:
Supervisory
Level

Education, experience, other comments

JOB CONTROLS AND
COMPLEXITY
CONTRACTS
PHYSICAL ENVIRONMENT

Remarks

ORS Form 15-1P

12

August 2023

OCCUPATIONAL REQUIREMENTS SURVEY –

Schedule Number:

Base Leveling Supervisor

Supervisor
1st

2nd

Quote:

3rd

Line Supervisor/Manager

Occupation:

Establishment Grade:

SOC:

Establishment Rate Range:

Establishment Job Title:

Highest Level Non-Supervisory Subordinate Position _________________________________________________
Factor

KNOWLEDGE

Level

Education, experience, other comments

JOB CONTROLS AND
COMPLEXITY
CONTACTS
PHYSICAL ENVIRONMENT

Remarks

ORS Form 15-1P

13

August 2023

OCCUPATIONAL REQUIREMENTS SURVEY –
Leveling on Duties and Responsibilities of Supervisor

Schedule Number:

Supervisor
1st

2nd

Quote:

3rd

Line Supervisor/Manager

Occupation:

Establishment Grade:

SOC:

Establishment Rate Range:

Factor

KNOWLEDGE

Establishment Job Title:

Level

Education, experience, other comments

JOB CONTROLS AND
COMPLEXITY
CONTACTS
PHYSICAL ENVIRONMENT

Remarks

ORS Form 15-1P

14

August 2023

OCCUPATIONAL REQUIREMENTS SURVEY –

Schedule Number:

Leveling Summary

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

ORS Form 15-1P

15

August 2023

OCCUPATIONAL REQUIREMENTS SURVEY Work Schedule

Quote #

Work Schedule #

Schedule Number:

Description/occupation

Hours/day

Hours/week

Weeks/year Type

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

ORS Form 15-1P

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August 2023

Remarks

ORS Form 15-1P

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August 2023