Working Conditions, Physical and Mental Requirements
Frequency: Place an
“X” in each box that is appropriate to your job.
|
NEVER (N) |
OCCASIONALLY (O) |
FREQUENTLY (F) |
CONSTANTLY (C) |
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|
0 % of Shift |
1-33% of Shift |
34-66% of Shift |
67-100% of Shift |
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|
Working Conditions |
N |
O |
F |
C |
Working Conditions |
N |
O |
F |
C |
|
Physical
Demands |
|
|
|
|
Depth Perception |
|
|
|
X |
|
Standing |
|
|
X |
|
Color Distinction |
|
|
|
X |
|
Walking |
|
|
X |
|
Peripheral Vision |
|
|
|
X |
|
Sitting |
|
|
X |
|
Driving |
|
|
X |
|
|
Lifting |
|
|
X |
|
Physical Strength: |
|
|
|
|
|
Carrying |
|
|
X |
|
Little Physical Effort (-10 lbs.) |
|
X |
|
|
|
Pushing |
|
X |
|
Light Work (-20 lbs.) |
|
|
X |
|
|
|
Pulling |
|
X |
|
Medium Work (20-50 lbs.) |
|
X |
|
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|
Climbing |
|
X |
|
|
Heavy Work (50-100 lbs.) |
|
X |
|
|
|
Balancing |
|
|
X |
|
Very Heavy Work (100+ lbs.) |
X |
|
|
|
|
Stooping |
|
X |
|
Environmental
Conditions |
|
|
|
|
|
|
Kneeling |
|
X |
|
Cold (50 degrees F or less) |
|
X |
|
|
|
|
Crouching |
|
X |
|
Heat (90 degrees F or more) |
|
X |
|
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|
Crawling |
|
X |
|
|
Temperature Changes |
|
|
X |
|
|
Reaching |
|
|
X |
|
Wetness |
|
X |
|
|
|
Handling |
|
|
X |
|
Humidity |
|
X |
|
|
|
Grasping |
|
|
X |
|
Extreme Noise or Vibration |
|
|
X |
|
|
Twisting |
|
X |
|
|
Exposure to Chemicals |
|
X |
|
|
|
Feeling |
|
X |
|
Exposure to Gases and Fumes |
|
X |
|
|
|
|
Talking |
|
|
X |
|
Exposure to Unpleasant Odors |
|
X |
|
|
|
Hearing |
|
|
X |
|
Exposure to bodily fluids |
|
X |
|
|
|
Repetitive Motion |
|
|
X |
|
Exposure to dampness |
|
X |
|
|
|
Hand/Eye/Foot Coordination |
|
|
X |
Confinement to Small or Restricting Area |
X |
|
|
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|
Visual Acuity/Near |
|
|
|
X |
Mechanical Hazards |
|
|
X |
|
|
Visual Acuity/Far |
|
|
|
X |
Physical danger or abuse |
|
X |
|
|
The above statements are intended to describe the general nature and level of work being performed by the employee assigned to this position. They are not to be construed as an exhaustive list of all job responsibilities and duties performed by personnel so classified.
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