Clean Air Champion Application
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Tell us about your organization:
Organization Name *
As it should appear on the award and related media materials.
Nature of your business *
(e.g. Medical Services, Oil and Gas, Engineering, Consultant)
Total number of Employees *
Approximate number of employees in the Houston-Galveston-Brazoria nonattainment region *
This includes Harris, Brazoria, Chambers, Fort Bend, Galveston, Liberty, Montgomery and Waller Counties)
Approximate number of employees in the HGB nonattainment region who are offered the benefits described *
Your Organization's Website *
How did you hear about the Clean Air Champion Program? *
Name of Primary Point of Contact *
This should be the person who we can call if we have questions and who will complete the quarterly updates
Title *
Phone *
Email Address *
Mailing Address: *
Name of an alternate Point of Contact: *
Title of Alternate Point of Contact *
Phone of Alternate Point of Contact *
Email of Alternate Point of Contact *
The following questions are intended to gather information about the type of commuter benefits your organization has offered IN THE PAST:
In the past year, has your organization supported alternative commuting methods for employees?
In the past year, how many employee work trips has your organization reduced?
If you answered the previous question, what was the average length of the employee work trips reduced?
Your answer should be in number of miles.
Over the past year, what percentage of employees have utilized an alternative to single occupancy vehicle commuting?
If you answered the question above, how many days per week on average have they used an alternative?
Does your organization offer a compressed work schedule? *
(i.e. 9/80, 4/10, 3/12)
If you answered yes to the previous question, what percentage of employees is a compressed work schedule offered to?
What percentage of employees are on a 9/80 schedule?
Employees work a week of four 9-hour days and one 8-hour day followed by a week of four 9-hour days
What percentage of employees are on a 4/10 work schedule?
Employees work four 10-hour days a week
What percentage of employees are on a 3/12 schedule?
Employees work three 12-hour days a week
Does your organization allow telecommuting? *
If you answered yes to the previous question, what percentage of employees telecommute?
On average, how many days per week do these employees telecommute?
Does your organization provide an incentive toward the cost of transit or vanpool? *
If you answered yes to the previous question, how much does your organization provide per month?
Approximately how many employees utilize this benefit?
Does your organization provide a monthly incentive in lieu of providing a parking spot to each employee who leaves their car at home and commutes via an altenative method? *
If so, how much does your organization provide to each employee monthly?
Approximately, how many employees utilize this benefit?
Has your organization taken other measures to reduce employee's single occupancy vehicle trips and/or to promote commute alternatives?
Please describe the other measures implemented as well as any results observed.
The following questions are intended to gather information about what commuter benefits your organization is CURRENTLY offering:
Is you organization supporting and encouraging alternative commuting methods for employees? *
Does your organization offer a compressed work schedule?
Clear selection
If you answered yes to the previous question, please tell us the approximate number of employees this is offered to?
Please provide your answer as a percentage.
Does your organization currently allow telecommuting? *
If you answered yes to the previous question, please tell us the approximate number of employees that are allowed to telecommute.
Please provide your answer as a percentage.
On average, how many days per week are these employees allowed to telecommute?
If applicable, please provide the amount that your organization currently provides per month towards the cost of transit or vanpool.
If applicable, please provide the amount that your organization provides per month in lieu of providing a parking spot to each employee who leaves their car at home and commutes via an alternative method.
Does your organization currently promote ridesharing/carpooling to employees by encouraging them to participate in the NuRide program which provides rewards to users who record their alternative commute trips? *
There is no cost for participation, learn more at www.NuRide.com
Does your organization provide preferred parking or reduced parking costs for carpools and/or vanpools? *
Does your organization provide flexible work schedules to those employees whose duties do not preclude flexible hours? *
Does your organization provide employees with the option of a pre-tax transit/vanpool deduction from their paychecks? *
Does your organization provide incentives to encourage employees to live closer to work? *
Does your organization provide secure bicycle racks, showers, and/or lockers? *
Does your organization offer a proximate commute? *
This is where employees work at locations closer to their homes.
Does your organization hold an active membership in a Transportation Management Organization (TMO) or actively participate in a voluntary regional air quality program (e.g., Spare the Air, Air Awareness, SEQL, Clean Air Coalition) or another employer-based commuter program? *
Does your organization hold an active membership in a local ozone awareness program? *
(e.g. Clean Cities)
Does your organization provide a workplace with on-site amenities? *
(e.g. cafeteria, restaurant, post box, ATM, dry cleaning, etc.)
Does your organization provide membership in a car sharing program? *
Visit www.carsharing.net to learn more.
Does your organization have an employee recognition program that promotes alternative commuting? *
Does your organization provide incentives to encourage employees to utilize alternative transportation? *
(e.g. the ability to earn additional vacation, quarterly raffle prizes, etc.)
Is your organization taking other measures to reduce employees’ single occupancy vehicle trips and/or to promote commute alternatives?
Please describe the other measures your organization will be taking:
Maintaining Your Designation
In order for us to document the air quality benefits resulting from your organization’s efforts it is necessary that the following information be tracked by your organization and provided to the H-GAC Air Quality Program on a quarterly basis: the approximate rate of employee utilization of each of the specific commuter benefits being offered (or the number of employees using each benefit), the average distance commuted by your employees, and a reasonable estimate of the single occupancy vehicle trips prevented by your program. One of the easiest ways to track this information is to require employees who utilize your organization’s commuter benefits to track the resulting trip reduction on the NuRide system. This system is available at no cost at www.NuRide.com.

Air quality staff will be glad to work with employers as needed to obtain reasonable quarterly estimates of these figures. Please direct any inquiries about obtaining these figures to Katrina Bayer at 832-681-2557.    

Please select one of the following: *
Required
Should your organization receive the Clean Air Champion designation, do you agree to actively promote their commuter benefits to eligible employees and to look for opportunities to use the Clean Air Champion name and logo to promote their designation? *
Media Recognition
We would like to help you publicize your designation as Houston-Galveston Area Clean Air Champion:
May we list your organization as a Clean Air Champion in media releases or other publicity? *
May we specify which commuter benefits you offer? *
Are you interested in additional recognition opportunities? *
(e.g. case studies, program profiles, newsletter features, news articles, etc.)
Who should we contact if an opportunity for additional recognition arises?
Name:
Title:
Phone:
Email:
Is there anything else you would like us to know about your organization?
Do you have any questions or comments regarding the Clean Air Champion Program?
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