Employment Recovery DWG - Suggested Employer Data Worksheet_final.pdf

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National Dislocated Worker Grants Program Guidance
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ETA-TEGL-12-19
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Employment Recovery DWG - Suggested Employer Data Worksheet

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Employment Recovery DWG – Suggested Employer Data Worksheet

EMPLOYMENT RECOVERY NATIONAL DISLOCATED WORKER GRANT (DWG)

SUGGESTED EMPLOYER DATA WORKSHEET

Employer Information Layoff Notification Layoff Data Rapid Response

Company or

Military Installation Address of Facility

Notification

Type

Date of

Notification

Closure:

Y/N

Layoff

Date(s)

Number of

Affected

Workers

Number of

Planned

Participants

Contact with

Employer

Date

Contact with

Workers

Date

Number of

Affected

Workers

Contacted

Number of

Field

Surveys

Completed

Company or Military InstallationRow1:
Address of FacilityRow1:
Notification TypeRow1:
Date of NotificationRow1:
Closure YNRow1:
Layoff DatesRow1:
Number of Affected WorkersRow1:
Number of Planned ParticipantsRow1:
Contact with Employer DateRow1:
Contact with Workers DateRow1:
Number of Affected Workers ContactedRow1:
Number of Field Surveys CompletedRow1:
Company or Military InstallationRow2:
Address of FacilityRow2:
Notification TypeRow2:
Date of NotificationRow2:
Closure YNRow2:
Layoff DatesRow2:
Number of Affected WorkersRow2:
Number of Planned ParticipantsRow2:
Contact with Employer DateRow2:
Contact with Workers DateRow2:
Number of Affected Workers ContactedRow2:
Number of Field Surveys CompletedRow2:
Company or Military InstallationRow3:
Address of FacilityRow3:
Notification TypeRow3:
Date of NotificationRow3:
Closure YNRow3:
Layoff DatesRow3:
Number of Affected WorkersRow3:
Number of Planned ParticipantsRow3:
Contact with Employer DateRow3:
Contact with Workers DateRow3:
Number of Affected Workers ContactedRow3:
Number of Field Surveys CompletedRow3:
Company or Military InstallationRow4:
Address of FacilityRow4:
Notification TypeRow4:
Date of NotificationRow4:
Closure YNRow4:
Layoff DatesRow4:
Number of Affected WorkersRow4:
Number of Planned ParticipantsRow4:
Contact with Employer DateRow4:
Contact with Workers DateRow4:
Number of Affected Workers ContactedRow4:
Number of Field Surveys CompletedRow4:
Company or Military InstallationRow5:
Address of FacilityRow5:
Notification TypeRow5:
Date of NotificationRow5:
Closure YNRow5:
Layoff DatesRow5:
Number of Affected WorkersRow5:
Number of Planned ParticipantsRow5:
Contact with Employer DateRow5:
Contact with Workers DateRow5:
Number of Affected Workers ContactedRow5:
Number of Field Surveys CompletedRow5:
Company or Military InstallationRow6:
Address of FacilityRow6:
Notification TypeRow6:
Date of NotificationRow6:
Closure YNRow6:
Layoff DatesRow6:
Number of Affected WorkersRow6:
Number of Planned ParticipantsRow6:
Contact with Employer DateRow6:
Contact with Workers DateRow6:
Number of Affected Workers ContactedRow6:
Number of Field Surveys CompletedRow6:
Company or Military InstallationRow7:
Address of FacilityRow7:
Notification TypeRow7:
Date of NotificationRow7:
Closure YNRow7:
Layoff DatesRow7:
Number of Affected WorkersRow7:
Number of Planned ParticipantsRow7:
Contact with Employer DateRow7:
Contact with Workers DateRow7:
Number of Affected Workers ContactedRow7:
Number of Field Surveys CompletedRow7:
Company or Military InstallationRow8:
Address of FacilityRow8:
Notification TypeRow8:
Date of NotificationRow8:
Closure YNRow8:
Layoff DatesRow8:
Number of Affected WorkersRow8:
Number of Planned ParticipantsRow8:
Contact with Employer DateRow8:
Contact with Workers DateRow8:
Number of Affected Workers ContactedRow8:
Number of Field Surveys CompletedRow8:
Company or Military InstallationRow9:
Address of FacilityRow9:
Notification TypeRow9:
Date of NotificationRow9:
Closure YNRow9:
Layoff DatesRow9:
Number of Affected WorkersRow9:
Number of Planned ParticipantsRow9:
Contact with Employer DateRow9:
Contact with Workers DateRow9:
Number of Affected Workers ContactedRow9:
Number of Field Surveys CompletedRow9:
Company or Military InstallationRow10:
Address of FacilityRow10:
Notification TypeRow10:
Date of NotificationRow10:
Closure YNRow10:
Layoff DatesRow10:
Number of Affected WorkersRow10:
Number of Planned ParticipantsRow10:
Contact with Employer DateRow10:
Contact with Workers DateRow10:
Number of Affected Workers ContactedRow10:
Number of Field Surveys CompletedRow10:
Company or Military InstallationRow11:
Address of FacilityRow11:
Notification TypeRow11:
Date of NotificationRow11:
Closure YNRow11:
Layoff DatesRow11:
Number of Affected WorkersRow11:
Number of Planned ParticipantsRow11:
Contact with Employer DateRow11:
Contact with Workers DateRow11:
Number of Affected Workers ContactedRow11:
Number of Field Surveys CompletedRow11:
Company or Military InstallationRow12:
Address of FacilityRow12:
Notification TypeRow12:
Date of NotificationRow12:
Closure YNRow12:
Layoff DatesRow12:
Number of Affected WorkersRow12:
Number of Planned ParticipantsRow12:
Contact with Employer DateRow12:
Contact with Workers DateRow12:
Number of Affected Workers ContactedRow12:
Number of Field Surveys CompletedRow12:
Company or Military InstallationRow13:
Address of FacilityRow13:
Notification TypeRow13:
Date of NotificationRow13:
Closure YNRow13:
Layoff DatesRow13:
Number of Affected WorkersRow13:
Number of Planned ParticipantsRow13:
Contact with Employer DateRow13:
Contact with Workers DateRow13:
Number of Affected Workers ContactedRow13:
Number of Field Surveys CompletedRow13:
Company or Military InstallationRow14:
Address of FacilityRow14:
Notification TypeRow14:
Date of NotificationRow14:
Closure YNRow14:
Layoff DatesRow14:
Number of Affected WorkersRow14:
Number of Planned ParticipantsRow14:
Contact with Employer DateRow14:
Contact with Workers DateRow14:
Number of Affected Workers ContactedRow14:
Number of Field Surveys CompletedRow14:
Company or Military InstallationRow15:
Address of FacilityRow15:
Notification TypeRow15:
Date of NotificationRow15:
Closure YNRow15:
Layoff DatesRow15:
Number of Affected WorkersRow15:
Number of Planned ParticipantsRow15:
Contact with Employer DateRow15:
Contact with Workers DateRow15:
Number of Affected Workers ContactedRow15:
Number of Field Surveys CompletedRow15:
Company or Military InstallationRow16:
Address of FacilityRow16:
Notification TypeRow16:
Date of NotificationRow16:
Closure YNRow16:
Layoff DatesRow16:
Number of Affected WorkersRow16:
Number of Planned ParticipantsRow16:
Contact with Employer DateRow16:
Contact with Workers DateRow16:
Number of Affected Workers ContactedRow16:
Number of Field Surveys CompletedRow16:
Company or Military InstallationRow17:
Address of FacilityRow17:
Notification TypeRow17:
Date of NotificationRow17:
Closure YNRow17:
Layoff DatesRow17:
Number of Affected WorkersRow17:
Number of Planned ParticipantsRow17:
Contact with Employer DateRow17:
Contact with Workers DateRow17:
Number of Affected Workers ContactedRow17:
Number of Field Surveys CompletedRow17:
Company or Military InstallationRow18:
Address of FacilityRow18:
Notification TypeRow18:
Date of NotificationRow18:
Closure YNRow18:
Layoff DatesRow18:
Number of Affected WorkersRow18:
Number of Planned ParticipantsRow18:
Contact with Employer DateRow18:
Contact with Workers DateRow18:
Number of Affected Workers ContactedRow18:
Number of Field Surveys CompletedRow18:
Company or Military InstallationRow19:
Address of FacilityRow19:
Notification TypeRow19:
Date of NotificationRow19:
Closure YNRow19:
Layoff DatesRow19:
Number of Affected WorkersRow19:
Number of Planned ParticipantsRow19:
Contact with Employer DateRow19:
Contact with Workers DateRow19:
Number of Affected Workers ContactedRow19:
Number of Field Surveys CompletedRow19:

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