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ORS Form 15-1P 

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

Expires 08/31/2024

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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 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
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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
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ORS Form 15-1P 

Remarks
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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
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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
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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
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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