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pdfPhase 2 Panel 3
Green Technologies and Practices
O.M.B. No. 1220−0182
Expires 12/31/11
Please provide information only for this location, even if you are a multi-location business, and return the form in the envelope
provided. Complete the form even if you do not have any green jobs or practices at your location. If you need help
completing this form, please send an email to info@usdol.websrg.com, or call 1-800-341-3660. Please return the form within 15 days.
1
If the physical location address shown below is no longer correct, please provide corrections in the space
provided.
ATTN:
Owner
Company Name Inc.
Report for:
1 Main St. Suite 111
Winooski, ST 11111
Enter address
corrections
here
2
What was the total employment at this location as of March 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 in Column A whether this location has actively used the type of green technology or practice listed during the pay period including
March 12, 2011.
Column B:
For any green technologies or practices used during that same pay period at this location, 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. If you answered ‘no’ or ‘does not apply’ for all items in Column A,
or ‘no’ for all items in Column B, please enter a zero in Question 5.
3
5
Please provide the total number of employees at this location who spent more than half of their time using green
technologies or practices in the pay period including March 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
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?
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
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: Bureau of Labor Statistics Green Jobs
Strategic Research Group
995 Goodale Blvd.
Columbus, OH 43212
Confidentiality Statement. The Bureau of Labor Statistics, its employees and agents, 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 30 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 1220-0182 and expires on December 31, 2011. Without a currently valid number BLS would not be able to
conduct this survey.
6
| File Type | application/pdf |
| Author | downey_k |
| File Modified | 2011-03-23 |
| File Created | 2011-03-23 |