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#PBT-5177-096819
Supplemental Questionnaire

Last Name
First Name

 

5177 Safety Officer

PBT-5177-096819

Supplemental Questionnaire

All applicants are required to complete the Supplemental Questionnaire as part of the online application process. Responses cannot be changed or edited after submission. Insufficient or non-responsive answers to the Supplemental Questionnaire may result in ineligibility, disqualification, or lower scores.  

Responses to items on the Supplemental Questionnaire must be supported by the information provided on the application in order to receive appropriate credit. Please provide a response to each question below to the best of your ability.  Please provide all information requested even if the information may appear redundant. Do not write, "See application" or “See resume.”  

All experience and education referenced in this questionnaire MUST also appear in the work history and/or education sections of your application. The information provided must be consistent with the information on your application and is subject to verification

NOTE: Falsifying one's education, training, or work experience or attempted deception on the application or Supplemental Questionnaire may result in disqualification for this and future job opportunities with the City and County of San Francisco. 

There are two sections to the Supplemental Questionnaire.  Section 1 (Question #1 to #9) is designed to assess your qualifications to determine whether you meet the minimum qualifications for this position.  Section 2 (Question # 10 to #13) is designed to assess your knowledge, skills, and abilities in job related areas identified as critical for performance in this position.  Section 2 will be scored and may account for 100% of your final score on the eligible list score report.  

It is suggested that you:

  • Allow ample time to submit your application and Supplemental Questionnaire responses before the filing deadline
  • Ensure that your responses are sufficiently detailed to assist in evaluating your knowledge, skills, and abilities
  • Make note of any error messages and contact the analyst before the filing deadline, if you experience technical difficulties.

INSTRUCTIONS: The purpose of the Minimum Qualification Supplemental Questionnaire is to assess whether the applicant meets the minimum qualifications for the classification. The minimum qualifications have been identified as critical for satisfactory performance in this classification. The information provided must be consistent with the information on your application and is subject to verification. The responses on the Supplemental Questionnaire are mandatory for participation in this recruitment process.



 

Section 1


1.

Do you possess a Baccalaureate Degree?

Note: All education must also be indicated in the Education section of the application in order to be considered.

Yes No
2.

Please select the degree program of study for your Baccalaureate degree.

Note: All education must also be indicated in the Education section of the application in order to be considered.

Safety
Occupational Safety and Health
Safety Management
Engineering
Physical Science
Natural Science
A closely related field to one of the above
A field not closely related to one of the above
I do not possess a Baccalaureate degree
3.

Do you possess a Master's Degree?

Note: All education must also be indicated in the Education section of the application in order to be considered.

Yes No
4.

Please select the degree program of study for your Master's degree.

Note: All education must also be indicated in the Education section of the application in order to be considered.

Safety
Occupational Safety and Health
Safety Management
A closely related field to one of the above
Engineering
Physical Science
Natural Sciences
A field not closely related to one of the above
I do not possess a Master's degree
5.

How many years of professional industrial or occupational safety experience do you possess? The experience must include work safety assessments, engineering design review, accident investigation, safety program development, and safety management.

Note: All experience must also be indicated in the Employment Record section of the application in order to be considered.

Less than 4 years
More than 4 years but less than 5 years
More than 5 years but less than 6 years
More than 6 years but less than 7 years
More than 7 years but less than 8 years
8 or more years
6.

Do you possess a current valid Certification as a Certified Safety Professional (CSP) by the American Board of Certified Safety Professionals?

Note: All Professional License information, including license number, issuance date, and expiration date, must also be indicated in the Professional Licenses, Certification, or Registration section of the application in order to be considered.

Yes No
7.

Do you possess a current valid registration as a Professional Engineer in Safety by the State Board for Professional Engineers, Land Surveyors, and Geologists?

Note: All Professional License information, including license number, issuance date, and expiration date, must also be indicated in the Professional Licenses, Certification, or Registration section of the application in order to be considered.

Yes No
8.

Are you willing and able to wear personal protective equipment, such as a respirator, and have the ability to climb ladders, bend, squat, and crawl in tight spaces to safely access work sites? 

Note: A medical examination and the probationary period will be used to evaluate this qualification. 

Yes No
9.

Do you possess a current valid driver's license?

Note:  Please include your driver's license information in the application. 

Yes No

 

Section 2



 

SUPPLEMENTAL QUESTIONNAIRE EXAMINATION

5177 SAFETY OFFICER (PBT-5177-096819)

SF PUBLIC UTILITIES COMMISSION 

PLEASE READ THE FOLLOWING EXAM INSTRUCTIONS CAREFULLY AS IT CONTAINS INFORMATION THAT MAY AFFECT YOUR SCORE AND RANK ON THE ELIGIBLE LIST

All applicants are required to complete the following Supplemental Questionnaire examination as part of the selection procedures. The Supplemental Questionnaire examination must be submitted with your application by the final filing date. This examination does not substitute for the online application. 

The purpose of this examination is to assess your knowledge, skills, and abilities in job related areas identified as critical for performance in this position. The quality of your responses may account for 100% of the total weight of your final score on the eligible list score report.

A passing score must be achieved on the examination in order to continue in the recruitment process. Successful candidates will be placed on the eligible list score report in rank order according to their final combined score.

Please note: All relevant experience, education and/or training must be included in the spaces provided in order to be reviewed in the rating process. Panel members involved in the rating process will NOT have access to your application and resume, so it is important that you are thorough and complete. Your written communication skills will also be evaluated based on your responses.

It is suggested that you:

  • Allow ample time to submit your application and Supplemental Questionnaire examination responses before the filing.
  • Review the questions first, prepare and save your responses in a word processing document, and then paste them into the online Supplemental Questionnaire examination.
  • Be as concise as possible in your responses.
  • Ensure that your responses are sufficiently detailed enough to showcase your knowledge, skills, and abilities.
  • Provide your best or highest examples of your experience. If a question does not relate to you, provide the most closely related answer possible.
  • Do not write "see application" or "see resume" as a response.

The responses that you provide to this examination must be consistent with the information on your application and are subject to verification. Please limit your response for each question to no more than 1 page long.

Once you click on the submit button, your application and Supplemental Questionnaire examination are subject for review. Responses cannot be changed or edited after submission. Please keep a copy of the Supplemental Questionnaire examination for your own records.


10.

Please describe a time in which you had to assist in implementing and maintaining a positive safety culture in your organization. In your response, please provide a specific example and include the following information:

  1. What was your role, responsibilities, and goal of the implementation?
  2. What principles and practices of occupational safety and health were considered?
  3. The size of the organization.
  4. Any setbacks you may have encountered? How were they resolved? What was the outcome?
11.

Please describe your experience in performing a safety analysis, such as gap analysis, trend analysis, or other types of evaluations on workplace safety and potential hazards. In your response, please provide the following information:

  1. What was your role and responsibilities.
  2. Describe the scope, methods, and complexity of the analysis. 
  3. What were the results and insights drawn from the analysis? Were there any changes or safety recommendations that resulted from your findings?
12.

What was your role in effectuating an Injury and Illness Prevention Program (IIPP) into your work culture? In your response, please provide the following information:

  1. Your role and responsibilities. 
  2. Describe the program and your implementations.  
  3. What were the greatest challenges and how did you overcome them?
  4. What would you do differently in future IIPP implementation?
13.

Please provide an example of a time you had to conduct an accident investigation at your facility.  In your response, please provide the following information:

  1. What steps did you have to take to investigate the accident?
  2. Did it required Cal/OSHA notification? If so, describe your interaction with Cal/OSHA?
 

CERTIFICATION: I hereby certify that I am the author of this questionnaire and that all information is true and based on my education, training, skills, and experience. I understand that any false or incorrect statement may result in my disqualification of the selection process for this 5177 Safety Officer examination and/or dismissal from employment with the City and County of San Francisco. I also understand and agree that any information provided is subject to verification.