1 

ORS Form 15-1P 

U.S. Department of Labor

Bureau of Labor Statistics

Occupational Requirements 

Survey 

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, 

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

Expires 8/31/2021

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 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
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ORS Form 15-1P 

 

 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
3 

ORS Form 15-1P 

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
4 

ORS Form 15-1P 

Remarks
5 

ORS Form 15-1P 

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
6 

ORS Form 15-1P 

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
7 

ORS Form 15-1P 

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
8 

ORS Form 15-1P 

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
9 

ORS Form 15-1P 

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
10

ORS Form 15-1P 

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
11

ORS Form 15-1P 

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
12

ORS Form 15-1P 

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
13

ORS Form 15-1P 

OCCUPATIONAL REQUIREMENTS SURVEY – 

Base Leveling Supervisor

Schedule Number:

Supervisor

1st 2nd 3rd 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
14

ORS Form 15-1P 

OCCUPATIONAL REQUIREMENTS SURVEY – 

Leveling on Duties and Responsibilities of Supervisor

Schedule Number:

Supervisor

1st 2nd 3rd 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
15

ORS Form 15-1P 

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
16

ORS Form 15-1P 

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)
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ORS Form 15-1P 

Remarks