F. Working Environment. Please check all the items listed below that can help describe the working conditions and special demands of your job. Make
your estimates for normal conditions, not extreme situations. Check all that apply.
1. Regularity of Work Hours 4. Physical Effort:
( ) regular, per the established work schedule ( ) ordinary office, mostly sitting
( ) recurring late/early hours (less than 4 hours per week) ( ) extended standing, some lifting under 10 lbs, % of time:
( ) frequent early/late hours (not compensated for) ( ) lifting, objects under 50 lbs, list % of time:
2. Work on a computer screen: ( ) lifting, objects over 50 lbs, list % of time
( ) less than 25% ( ) operation of demanding equipment. list % of time:
( ) 25 - 50% 5. Health/Safety Exposure:
( ) more than 50% ( ) Noise extremes, list % of time exposed:
3. Physical Movements ( ) Ventilation extremes, list % of time exposed:
( ) Climbing or pulling self upward, % of time
( ) Bad weather, list % of time exposed:
( ) Kneeling/stooping/crawling/crouching, % of time
( ) Safety Hazards, list % of time exposed:
( ) Balancing, on unstable surfaces, % of time
( ) Contamination, exposure to disease or toxic substances,
( ) Guiding, feeding materials into proper position, % of time
( ) list % of time exposed:
IV. ESSENTIAL RESPONSIBILITIES
What are the major duties and responsibilities of your position? And how are they performed? Please list, in order of importance, brief statements describing
the duties that you perform or the work for which you are accountable. Please indicate how you accomplish each major duty and how you would know how
well it has been accomplished. As a general rule, a "major duty" should be listed only if it represents more than 5% of your time.
Please describe the major duties or responsibilities of Explain the steps, tasks, or activities that are How would you measure how well you have
your job in order of importance. required to accomplish this duty. accomplished this duty?
Responsibility. Steps, tasks, activities. Result or end product.