offical seal
Placer County Human Resources Department
#2020-14760-01


Supplemental Questionnaire

Last Name First Name
 

 

Management Analyst

(Safety/Workers' Compensation Analyst)

Supplemental Questionnaire



 

 Part I: Training and Experience Examination (Scored)

 

This supplemental questionnaire will serve as the Civil Service examination for this recruitment and will be scored based on your checked responses below. Narratives provided by applicants describing training and/or experience will not be scored but will be available to the hiring authority and may be utilized for interview and selection determination.

Scores received from this section will determine applicant ranking and placement on the eligible list. Resumes, letters, and other materials will not be evaluated or considered as responses to the items in the supplemental questionnaire. In addition, responses to this questionnaire will not be used for determining minimum qualifications for this position.

By continuing in this examination process, you are certifying that all information provided in the supplemental questionnaire is true to the best of your knowledge.


 

I have read and understand the above instructions.


 


INSTRUCTIONS: For the following questions, select the response that best describes your level of job-related experience and/or training:


1.

Managing and responding to governmental regulatory agencies.

I have no or very limited experience performing this task.
I have some experience performing this task but would need additional training.
I have experience performing this task under close supervision.
I have experience performing this task independently under normal supervision.
I have experience providing training and/or consultation to others in the performance of this task.
 

If you indicated experience above, please briefly describe it below (include years of experience):

2.

Analyzing, managing, and adhering to policies, programs, and/or budgets in the public sector.

I have no or very limited experience performing this task.
I have some experience performing this task but would need additional training.
I have experience performing this task under close supervision.
I have experience performing this task independently under normal supervision.
I have experience providing training and/or consultation to others in the performance of this task.
 

If you indicated experience above, please briefly describe it below (include years of experience):

3.

Analyzing data relationships in spreadsheets and making logical conclusions and recommendations.

I have no or very limited experience performing this task.
I have some experience performing this task but would need additional training.
I have experience performing this task under close supervision.
I have experience performing this task independently under normal supervision.
I have experience providing training and/or consultation to others in the performance of this task.
 

If you indicated experience above, please briefly describe it below (include years of experience):

4.

Identifying and implementing potential or required changes to business practices, procedures, and/or programs.

I have no or very limited experience performing this task.
I have some experience performing this task but would need additional training.
I have experience performing this task under close supervision.
I have experience performing this task independently under normal supervision.
I have experience providing training and/or consultation to others in the performance of this task.
 

If you indicated experience above, please briefly describe it below (include years of experience):

5.

Working with elected officials, department heads, senior management, and Boards of Supervisors or City Council members.

I have no or very limited experience performing this task.
I have some experience performing this task but would need additional training.
I have experience performing this task under close supervision.
I have experience performing this task independently under normal supervision.
I have experience providing training and/or consultation to others in the performance of this task.
 

If you indicated experience above, please briefly describe it below (include years of experience):

6.

Evaluating and preparing settlement recommendations for resolution of injury claims.

I have no or very limited experience performing this task.
I have some experience performing this task but would need additional training.
I have experience performing this task under close supervision.
I have experience performing this task independently under normal supervision.
I have experience providing training and/or consultation to others in the performance of this task.
 

If you indicated experience above, please briefly describe it below (include years of experience):


 

 

Part II: Additional Relevant Experience (Not Scored)

 

Part II of this supplemental questionnaire will not be scored but will be available to the hiring authority and may be utilized for interview and selection determination. 


1.

Do you possess any safety or workers’ compensation-related professional certifications?

Yes No
 

If yes, please list the certificate(s) below:


 


INSTRUCTIONS: Please provide a detailed description of your training and/or experience in the following areas:

 


2.

Planning, developing, and coordinating safety programs, policies, and procedures related to injury prevention, workers’ compensation, liability and risk management, and/or employee wellness programs.

3.

Developing and coordinating training activities, classes, handbooks, manuals, course outlines, and other materials relating to employee safety and wellness.

4.

Developing and leading departmental safety representative meetings.

5.

Investigating workplace accidents, injuries, and illnesses, and utilizing injury trend data to identify causes and recommend measures to prevent reoccurrences.

6.

Inspecting and evaluating workplace environments and equipment to identify potential hazards and ensure compliance with local, state, and federal safety laws and regulations.

7.

Analyzing Cal/OSHA and other state and federal laws, regulations, and programs related to occupational safety and health.


 

 Thank you for completing the examination portion of the application process. We encourage applicants to review their answers for accuracy prior to submitting.

Please Save & Continue to move forward to the next tab. 

Be sure to select the "Submit" button once the application has been completed.  You will receive confirmation that the application has been submitted.  

A notice of your status will be sent to you after the posted final filing date.