* indicates a required field

2. Instructions

   Thank you for taking the time to complete and submit the form below. 

   The information you provide will be used as part of the legal record for your organization under the Commute Trip Reduction (CTR) law (https://app.leg.wa.gov/rcw/default.aspx?cite=70A.15.4000). If your answers indicate that you are not a CTR-affected employer, you can still participate in our program on a voluntary basis and receive all the services free of charge.

   Please submit the form even if you believe that the worksite is not required to participate under the CTR law. A staff person will contact you within five business days of receiving the form to discuss next steps.

   Questions? Please email: ashley.jones@piercecountywa.gov

4. Company Name*
5. Branch
7. Name of highest-ranking official at worksite*
8. Job Title*
10. Company Street Address*
11. City*
    -- Select One --Unincorporated Pierce CountyCity of DuPontCity of FifeCity of LakewoodCity of PuyallupCity of SumnerCity of TacomaCity of University PlaceOther
12. ZIP Code*
14. Total Number of Employees at site*

    Include full-time, part-time, remote/work from home/telework employees.

    “Employee” is defined as anyone, other than an independent contractor or seasonal agricultural employee, who receives financial or other remuneration in exchange for work provided to an employer, including owners or partners of the employer. Shareholders, principals and associates in a corporation, partners (general or limited) in a partnership and participants in a joint venture are considered to be employees under the law.

     Do not include contract or seasonal employees.

16. Total number CTR-affected employees at site*

    An employee is considered CTR-affected if they are scheduled to begin their workday between 6:00 AM and 9:00 AM on 2 or more weekdays, in a full-time position (at least 35 hours per week) intended to last at least 12 continuous months.  Remote, work from home, hybrid, and telework employees are CTR-affected.  

20. Please complete the following section to help us determine if your organization is affected by the Washington State Commute Trip Reduction Law. Instructions: Answering for your organization/employer, please check Yes or No for each question.

22. Question 1*

    My organization fits the definition of “employer.” My organization is a sole proprietorship, partnership corporation, unincorporated association, cooperative, joint venture, agency, department, district, or other individual or entity, whether federal, public, nonprofit, or private, that employs employees.

    1. Yes
    2. No
    3. Not sure
24. Question 2*

    My worksite has 100 or more employee positions. 100 or more employee positions at my worksite meet the definition of “employee.” This includes employees who work remote, from home, telework/telecommute or a hybrid schedule.

    1. Yes
    2. No
    3. Not sure
26. Question 3*

    100 or more full-time positions at my worksite are intended to be employed on a continuous basis for 52 weeks for an average of at least 35 hours per week or 70 hours every 2 weeks. The site might experience fluctuations in hours, such as a seasonal decline in hours, but picks back up after the season. 

    1. Yes
    2. No
    3. Not sure
28. Question 4*

    The full-time employee positions are scheduled to begin their workday between 6:00 am and 9:00 am on two or more weekdays. 

    1. Yes
    2. No
    3. Not sure
32. Assigned Employee Transportation Coordinator

    Complete this section if you have identified a staff person to the role of Employee Transportation Coordinator. 

    The Employee Transportation Coordinator is responsible for the implementation of your Commute Trip Reduction program and requirements. See the enclosed “Role of an Employee Transportation Coordinator (ETC)” document.        

34. ETC Name
35. ETC Title
37. ETC Phone
38. ETC Email
40. ETC's Supervisor
41. ETC's Supervisor Title
43. ETC Supervisor Phone Number
44. ETC's Supervisor Email
48. Certification from Highest Onsite Ranking Official*

    I certify that all employer recorded information above is true and correct to the best of my knowledge. I understand if this site meets the legal definition of an affected employer, this organization must comply with all requirements.       

    1. By checking this box, I certify the information recorded on this form.
50. First and Last Name*
51. Title*
53. Email*
54. Phone*
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

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