ESSENTIAL JOB FUNCTIONS TO INCLUDE BUT NOT LIMITED TO:
KEY: C – Constant F – Frequent O – Occasional N – Never/Does not apply
Sitting Standing Walking Bending Stooping
Kneeling Twisting Upper Body
Lifting up to (# of pounds)
Please check all that apply:
Crouching (ex. filing in cabinets not at arms level)
Manual dexterity for operation of business machines and/or equipment
Climbing hand-over-hand (ex. climbing a ladder)
Crawling (ex. laying cable inside a ceiling)
Vision to include:
Near Vision Far Vision Color Vision Peripheral Vision Depth Perception
Field of Vision (ex. see up, down & across when eyes are fixed)
Visual Accommodation (Bringing objects into focus ex. computer screen)
Communication to include:
Hearing: Ability to Hear Clearly/Distinctly (ex. phone receptionist vs. data entry only) Hearing not a factor
Good Command of English: Essential Preferred Not a factor
Environment:
Work is Performed: Inside Outside Both Inside/Outside
Exposure to: Extreme Noises Mechanical Hazards Electric Hazards
Fumes and/or odors associated with:
Dust and/or mites (paper dust, dust in ceiling while installing cable, etc.)
Temperatures: Climate controlled with proper heating/cooling
Varying temperatures due to nature and location of work
Extreme Heat Extreme Cold
Other (explain):
Lighting: Properly illuminated with overhead or desk/counter lighting
Properly illuminated and has windows
Department is accessible by:
Elevator Combination of elevator and stairs External Ramp
Electric Chair Lift (both east and west entrances) Accessible by stairs only (ex. departments on GC 4.5)
Other: (be specific):
