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pdfU.S. Department of Labor
Occupational Requirements
Survey
Bureau of Labor Statistics
The BLS publishes statistical tabulations from this survey that
This report is authorized by law, 31 United States
may reveal the information reported by individual State and
Code §§ 1535/FAR 17.5 of the Economy Act. Your
O.M.B. #1220-0189
local governments. Upon your request, however, the BLS will
voluntary cooperation is needed to make the results
hold the information provided on this survey form in confidence. of this survey comprehensive, accurate and timely.
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 (1220-0189), 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 GOVERNMENT 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 #:
Supplying
# 2:
Supplying
Authorizing
Telephone #:
FAX #:
# 3:
Authorizing
Telephone #:
FAX #:
ORS Form 15-1G
Title:
E-mail:
Address:
1,
2, or
COC.
Title:
Mail forms to
E-mail:
Address:
1,
2, or
COC.
Title:
Mail forms to
Email:
Address:
1,
2, or
COC.
Mail forms to
Supplying
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 15-1G
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 15-1G
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 15-1G
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 15-1G
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 15-1G
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 15-1G
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 15-1G
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 15-1G
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 15-1G
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 15-1G
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 15-1G
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 15-1G
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 15-1G
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 15-1G
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 15-1G
16
August 2023
Remarks
ORS Form 15-1G
17
August 2023
| File Type | application/pdf |
| Author | Carney, Paul - BLS |
| File Modified | 2023-06-01 |
| File Created | 2023-06-01 |