Complete this worksheet to request a group or
groups of employees be exempt from
your worksite's affected employee count. Click the submit button to send the
form electronically to your Employer Transportation Representative.
Or print and mail the form to:
Commute Trip Reduction Services
Request Information
Step 1:
The total
number of affected employees reported on your last program
submitted.
Step 2: Your
current total number of affected employees.
Step 3: How many of your current total number of affected
employees do you require to:
drive alone to work every day because of the type of work they
do or their work schedule, and
and use the vehicle they drove to work for work purposes during
the day, and
cannot use their vehicle to carpool or
vanpool?
Step 4: How many of your current total affected
employees:
work variable shifts throughout the year,
and
do not rotate as a group to identical shifts?
Do not count employees counted in Step 3 again in Step 4.
Step 5: What is your adjusted total number of affected
employees?
Step 6: For each group of employees counted in Step
3 and Step 4, provide a brief description of how they meet the stated
criteria.
Step 7: For employees counted in Step 3 and Step 4,
state their job title(s), the number of employees in each job title,
and their regular assigned work schedules.
Company Information
Organization name
Branch
Site address
City
State
Zip Code
Name
Date
Phone
E-mail
