GTP Survey Form Green Technologies and Practices Survey Form

Green Technologies and Practices
O.M.B. No. 1220−xxxx
Expires xx/xx/xxxx

105

Please provide information only for the location in number 1
below, even if you have more than one location.
Please respond within 30 days to reduce follow-up costs.

Please respond even if you do not use any green technologies or
practices at your location.
Need help? Send an e-mail to xxxxxxxxxxxxxxxx@xxx.xxx or call
1-xxx-xxx-xxxx.

You can respond using the Internet. For instructions please go to: www.bls.gov/respondents/gtp/forms.htm

1

If the physical location address shown below is no longer correct, please provide corrections in the space
provided.
Enter address
corrections
here

2

What was the total employment at this location as of August 12, 2011?

Enter total
employment
here

3

Include:

Do Not Include:

• For incorporated firms – paid owners, officers, and staff
• Total number of full- and part-time paid workers
• Workers assigned temporarily to other locations

• For unincorporated firms – owners, proprietors, and partners
• Unpaid family workers
• Workers on unpaid leave
• Workers not covered by unemployment insurance
• Contractors and temporary agency employees not on your
payroll

Our records show that your main products or services are related to those listed below. If they are not, please
list your main products or services in the space provided and continue with the rest of the survey.
Current product or service description:
Renting consumer electronics equipment and appliances,
such as televisions, stereos, and refrigerators. Included in this
industry are appliance rental centers.

Enter
corrections
here

Printed on Recycled Paper

4

Did your location use any of the following green technologies or practices?

Column A:
Please indicate whether this location actively used the type of green technology or practice listed during the pay period including August 12, 2011.
Column B:
For any green technologies or practices used at this location during that same pay period, please indicate whether there were any employees at this
location who spent any of their time involved in:



researching, developing, maintaining, using, or installing technologies or practices to lessen the environmental impact of their establishment, or
training the establishment’s workers in these technologies or practices.

Please include employees on the establishment’s payroll. Do not include contract employees or consultants when completing Column B.
The types of employees to include are listed in Question 2 on Page 1.

Item

Type of green technology or practice

Examples

Column A

Column B

Did your location …?

Did any of your employees …?

Energy from Renewable Sources and Energy Efficiency

1

2

Generate electricity, heat, or fuel
from renewable sources primarily
for use within your establishment?
Use technologies or practices to
improve energy efficiency within
your establishment?

•
•
•
•

Wind
Geothermal
Ocean
Landfill gas

• Biomass
• Solar
• Hydropower
• Municipal solid waste

•
•
•
•
•
•

Energy Star rated appliances
Occupying a LEED certified building
Energy efficient lighting
Programmable thermostats
Cogeneration (combined heat and power)
Energy efficient manufacturing equipment

Yes, If Yes
No

 Yes

 No

 Yes

 No

 Yes

 No

Does not apply

Yes, If Yes
No
Does not apply


Greenhouse Gas Reduction 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 above (renewable
energy generation and energy
efficiency)?

• Purchase and use of carbon offsets
• Promotion and/or subsidy of alternative
forms of transportation for employees,
such as carpools, fuel efficient vehicles,
cycling, or mass transit
• Implementation of a telework program
for employees

2

Yes, If Yes
No
Does not apply

Item

4

Type of green technology or practice

Use technologies or 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?

Examples

•
•
•
•
•
•
•
•

Carbon monoxide
Sulfur dioxide
Chlorofluorocarbons (CFCs)
Nitrogen oxides
Chlorinated hydrocarbons
Herbicides or pesticides
Heavy metals
Radioactive contamination

Column A

Column B

Did your location …?

Did any of your employees …?

Yes, If Yes

 Yes

 No

 Yes

 No

 Yes

 No

 Yes

 Yes

 No

 Yes

 Yes

 No

No
Does not apply

Recycling & Reuse and Natural Resources Conservation

5

6

Use technologies or practices to
reduce or eliminate the creation of
waste materials as a result of your
operations?

•
•
•
•

Collecting and reusing or recycling waste

Use technologies or practices in
your operations to conserve
natural resources? Please do not
include using recycled inputs in
your production processes.

•
•
•
•

Managing land resources
Managing storm water
Conserving soil, water, or wildlife
Implementing organic agriculture or
sustainable forestry practices

Managing wastewater

Yes, If Yes
No

Composting solid waste
Remanufacturing

Does not apply
Yes, If Yes
No
Does not apply

Other technologies or practices not included previously. Please describe.

7

8

Please complete Question 5 on the next page.
3

5

Please provide the total number of employees who spent more than half of their time involved in the green
technologies or practices reported in Question 4 in the pay period including August 12, 2011.
Please count each employee only once, even if they are included in Question 4 Column B
more than once.
Please do not include contractors or consultants working at your location that are not on your
location’s payroll.
If no employees spent more than half of their time on green activities, enter zero.

Enter the number of
employees involved
in green activities
here.

If you entered zero, please skip to Question 7.
If you entered one or more employees, please complete Question 6.

6

What are the occupations and wages of the employees reported in Question 5 who spent more than half of their time
involved in green technologies and practices?

1. Complete for employees who
spent more than half of their
time in green activities in
Question 5.
2. Please provide a job title, brief
description of duties, and the
number of workers by wage
category in the space provided.

A

B

C

D

E

F

G

H

I

J

K

L

Hourly
Wages

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

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

3. Report part-time employees at
their hourly rate.

Example:

Number of your
employees with this
salary or hourly
wage for this job
title

Job Title: Hydrologist
Job Description: Researches water

usage and implements wastewater
treatment plans

1

Job Title:
Job Description:

4

2

Total number of
your employees
with this job title
(3 in this example)

Total

3

Question 6 Continued

A

B

C

D

E

F

G

H

I

J

K

L

Hourly
Wages

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

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

Job Title:
Job Description:

Job Title:
Job Description:

Job Title:
Job Description:

Job Title:
Job Description:

Job Title:
Job Description:

Job Title:
Job Description:

If you need additional space, please copy this page and attach the completed page(s) to this form .
If done, please complete Question 7.

5

Total

7

Please tell us who provided the information on this form for:

Green Technologies and Practices:

Occupations and Wages:
Check here, if the same person as green technologies & practices

Contact Name:

Contact Name:

E-Mail:

E-Mail:

Job Title:

Job Title:

Business Website:

Business Website:

Phone Number:

Phone Number:

Thank you for completing this survey.
Please return this form in the enclosed envelope to:
Attn: Green Technologies and Practices Survey
Washington State Employment Services Division
Address Line 1
City, ST zip+4

Confidentiality Statement. 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 29 U.S.C. 2. Paperwork Reduction Act
Statement. Your voluntary cooperation is needed to make the results of this survey comprehensive, accurate, and timely. We estimate that completing this form will take an average of 20 minutes.
This estimate takes into account time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information. If you
have any comments regarding this survey, including suggestions for reducing the burden, send them to the Bureau of Labor Statistics, Office of Occupational Employment Statistics, Paperwork
Reduction Project, 2 Massachusetts Avenue, N.E., Room 2135, Washington, DC 20212. The OMB control number for this voluntary survey is 1220-xxxx and expires on xxxxx, xxxx. Without a
currently valid number BLS would not be able to conduct this survey.

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