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    • Contact information is found at the top of the front page.
    • Click in a section to go directly to that item.

    Front Page

    Question 1

    • If the address shown in Question 1 is no longer correct, please update your physical location address in the blank space provided.
    • Remember that this report is only for the physical location specified in Question 1.

    Question 1 box

    Question 2


    • Include:
      • For incorporated firms – paid owners, officers, and staff
      • Total number of full- and part-time paid workers
      • Workers assigned temporarily to other locations
    • Do not include:
      • 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

    Question 2 box

    Question 3

    • Please use the blank space in Question 3 to briefly explain your main products or services offered at this establishment if they are different from those indicated on the form, or if you have downloaded this form from the website.

    Question 3 box

     

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    Page 2

    Question 4 - Item 1

    • Please indicate in column A whether your establishment generated electricity, heat, or fuel from renewable sources primarily for use within your establishment.
    • If the answer is yes, please indicate in Column B whether any of your employees spent any of their time involved in researching, developing, maintaining, using, or installing technologies or practices related to generating electricity, heat, or fuel from renewable sources.
    • Examples of Renewable Energy

    Page 2 Question 4 - Item 1

    Question 4 - Item 2

    • Please indicate in Column A whether your establishment used technologies or practices to improve energy efficiency within your establishment.
    • If the answer is yes, please indicate in Column B whether any of your employees spent any of their time involved in researching, developing, maintaining, using, or installing technologies or practices related to improving energy efficiency.
    • Examples of Energy Efficiency

    Page 2 Question 4 - Item 2

    Question 4 - Item 3

    • Please indicate in Column A whether your establishment used technologies or practices in your operations to reduce greenhouse gas emissions through methods other than by generating energy from renewable sources or improving energy efficiency.
    • If the answer is yes, please indicate in Column B whether any of your employees spent any of their time involved in researching, developing, maintaining, using, or installing technologies or practices related to reducing greenhouse gas emissions.
    • Examples of Green House Gas (GHG) Emissions Reduction

    Page 2 Question 4 - Item 3

     

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    Page 3

    Question 4 - Item 4

    • Please indicate in Column A whether your establishment used 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.
    • If the answer is yes, please indicate in Column B whether any of your employees spent any of their time involved in researching, developing, maintaining, using, or installing technologies or practices related to reducing the release of pollution or toxic compounds resulting from operations, or removing pollution or toxic compounds from the environment.
    • Examples of Pollution Reduction and Removal

    Page 3 Question 4 - Item 4

    Question 4 - Item 5

    • Please indicate in Column A whether your establishment used technologies or practices to reduce or eliminate the creation of waste materials as a result of operations.
    • If the answer is yes, please indicate in Column B whether any of your employees spent any of their time involved in researching, developing, maintaining, using, or installing technologies or practices related to reducing waste resulting from operations.
    • Examples of Reusing and Recycling

    Page 3 Question 4 - Item 5

    Question 4 - Item 6

    • Please indicate in Column A whether your establishment used technologies or practices in your operations to conserve natural resources. Please do not include using recycled inputs in your production processes.
    • If the answer is yes, please indicate in Column B whether any of your employees spent any of their time involved in researching, developing, maintaining, using, or installing technologies or practices related to conserving natural resources in your operations.
    • Examples of Natural Resource Conservation

    Page 3 Question 4 - Item 6

    Question 4 - Items 7 and 8

    • If you have any additional green technologies and/or practices in place at your establishment please write them in the white space provided along with a brief description.
    • Please indicate in Column B whether any of your employees spent any of their time involved in researching, developing, maintaining, using, or installing these green technologies and practices at your establishment.

    Page 3 Question 4 - Items 7 - 8

     

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    Pages 4 and 5

    Question 5

    • Please enter the total number of employees at this location that spent more than half of their time using green technologies and practices in the pay period.
    • If you entered one or more employees, please complete question 6.
    • If no employees spent more than half their time on green activities, enter zero and please skip to question 7 located on the last page of the survey.
    • Include:
      • Each employee only once, even if they are included in Question 4 Column B more than once.
      • Zero (0) if no employees spent more than half of their time involved in green activities.
    • Do Not Include:
      • Contractors or consultants working at your location that are not on your location's payroll
      • Employees who passively use energy efficient technologies like CFLs, motion-detection lighting, and Energy Star rated appliances in their work.

    Question 6

    • For the employees that spent more than half of their time using green technologies and practices, enter their job titles and a brief job description.
    • For full-time workers, use annual salary or hourly wage to classify them. For part-time workers, use an hourly wage to classify them.
    • For example, there are 3 electricians in your establishment. Two are full-time: one earns $24,000 per year, and one earns $36,000. One is part-time (working 20 hours a week) and earns $11,000 per year.
    • For the full-time workers, use their annual wage: write "1" in Column C and "1" in Column D.
    • The hourly wage for the part-time worker is the annual wage divided by the number of hours worked.
    • 1. 20 hrs x 52 weeks = 1040 hrs/yr
      2. $11,000/1040 hrs = $10.58/hr
      3. Write "1" in column B
    • Add up the total number of workers for the occupation (3) and enter it in the Total Column.

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    • Please provide contact information for the person(s) who filled out this survey in case we have questions about the data provided.

    Pages 6

     

     

     

    Last Modified Date: October 4, 2012