* indicates a required field

2. Commute Trip Reduction Survey Set-up Request Form

   Please complete a form for each worksite located in Pierce County that needs to survey. Submit the form at least two weeks prior to your survey week. Employers need to complete their survey by November 20, 2026.   

   Questions? Please contact:

   • Rebekah Mingus, rebekahm@tacomaonthego.com
   • Debbie Germer, debbie.germer@piercecountywa.gov
4. First and Last Name:*
5. Work Email:*
7. Worksite Name, as it should be listed on the survey:*

   Examples: 

   • Pierce County
   • Pierce County - Downtown Campus 
   • Pierce County - 1243 Pine Street, Tacoma
8. This worksite is located:*

   1. In Tacoma
   2. Outside Tacoma
9. What week are you surveying?*
11. Worksite Physical Address (not mailing address):*
12. City:*
13. ZIP Code*
15. Who should I survey?
    • Employers need to survey all employees, including employees who work from home, work a hybrid schedule or telework. 
    • Hospitals and large employers with multiple shifts can survey just the shift that includes the 6-9 start time window.  
    • Small cities only need to survey employees at their city hall, adjacent buildings or buildings across a right-away. 
    • Universities and colleges only need to survey their staff. It is optional to include faculty and students.
17. Total number of employees at worksite:
18. Number of CTR-affected employees:*

    Number of full-time (35+ hours a week) employees scheduled to begin their workday between 6-9 am. 

19. Total number of employees to be surveyed:*
21. How many paper forms do you need for your site?
    1. Paper forms should be used sparingly.
    2. We will provide you a special form file. Each form will have a unique number. You can only distribute the form once. Copies of the form cannot be used.
    3. Forms are printed by the employer.
    4. You will scan the completed forms and email back a pdf file for processing.
    5. The results will be added to the online responses.
    6. In case you need to reissue a form to an employee, you must track who receives which form. This means that these responses will not be anonymous, just confidential.  
22. Other than English, which languages do you need paper forms for your worksite?

    1. Amharic
    2. Arabic
    3. Chinese
    4. Japanese
    5. Korean
    6. Lao
    7. Punjabi
    8. Russian
    9. Somali
    10. Spanish
    11. Tagalog
    12. Ukrainian
    13. Vietnamese
24. Select the message that your employees will see after they submit the survey.*

    1. Option 1: Thank you for submitting the survey. For commuter information visit RideTogetherPierce.com
    2. Option 2: Thank you for submitting the survey. For commuter information visit (employer website/SharePoint link)
    3. Option 3: Thank you for submitting the survey. To enter the prize drawing, email a screenshot of this page to {ETC email}.
    4. Option 4: Provide your own submit message in the box below.
26. Provide the needed text for Option 2, 3 or 4

    For Option 2, please provide the website/SharePoint url where employees can find information about your commute options program.

    Option 3 is ONLY for employers providing a prize drawing or incentive to employees for completing the survey. The survey responses are anonymous. Emails are not collected by the survey. This option allows employees to email you that they completed the survey. Please provide the email address to be used in this option. 

    For Option 4, please provide your own "Submit" text. 

28. Please email me personalized posters:

    1. My name and contact information - No QR code
    2. My name and contact information - with the QR code
    3. Both posters
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit