C = Continuously- 2/3 or more of the time. F = Frequently- From 1/3 to 2/3 of the time. O = Occasionally- Up to 1/3 of the time. R = Rarely- Less than 1 hour per week. N = Never- Never occurs.
Standing Frequently- From 1/3 to 2/3 of the time. Sitting Frequently- From 1/3 to 2/3 of the time. Walking Frequently- From 1/3 to 2/3 of the time. Lifting Rarely- Less than 1 hour per week. Lifting Amount Exerting up to 10 lbs Carrying Occasionally- Up to 1/3 of the time. Carrying Weight Exerting up to 10 lbs Pushing/Pulling Occasionally- Up to 1/3 of the time. Pushing/Pulling Weight Exerting up to 10 lbs Reaching Frequently- From 1/3 to 2/3 of the time. Handling Frequently- From 1/3 to 2/3 of the time. Fine Dexterity Frequently- From 1/3 to 2/3 of the time. Kneeling Rarely- Less than 1 hour per week. Crouching Rarely- Less than 1 hour per week. Crawling Never- Never occurs. Bending Occasionally- Up to 1/3 of the time. Twisting Rarely- Less than 1 hour per week. Climbing Rarely- Less than 1 hour per week. Balancing Occasionally- Up to 1/3 of the time. Vision Continuously- 2/3 or more of the time. Hearing Continuously- 2/3 or more of the time. Talking Frequently- From 1/3 to 2/3 of the time. Foot Controls N = Never Machines, Tools, Equipment and Work Aids Used Office Equipment to include computer, printer, calculator, scanner Protective Equipment Required N/A Health and SafetyD = Daily W = Several Times Per Week M = Several Times Per Month S = Seasonally N = Never
Mechanical Hazards S = Seasonally Chemical Hazards N = Never Electrical Hazards S = Seasonally Fire Hazards N = Never Explosives N = Never Communicable Diseases S = Seasonally Physical Danger or Abuse N = Never Other If Other, Description Environmental FactorsD = Daily W = Several Times Per Week M = Several Times Per Month S = Seasonally N = Never
Dirt and Dust S = Seasonally Extreme Temperatures S = Seasonally Noise and Vibration M = Several Times Per Month Fumes and Odors S = Seasonally Wetness/Humidity S = Seasonally Darkness or Poor Lighting N = Never Primary Work Location Office Environment Non-Physical DemandsC = Continuously- 2/3 or more of the time. F = Frequently- From 1/3 to 2/3 of the time. O = Occasionally- Up to 1/3 of the time. R = Rarely- Less than 1 hour per week. N = Never- Never occurs.
Time Pressures Frequently- From 1/3 to 2/3 of the time. Emergency Situations Occasionally- Up to 1/3 of the time. Frequent Change of Tasks Frequently- From 1/3 to 2/3 of the time. Irregular Work Schedule/Overtime Occasionally- Up to 1/3 of the time. Performing Multiple Tasks Simultaneously Continuously- 2/3 or more of the time. Working Closely with Others as Part of a Team Continuously- 2/3 or more of the time. Tedious or Exacting Work Frequently- From 1/3 to 2/3 of the time. Noisy/Distracting Environment Occasionally- Up to 1/3 of the time. Other If Other, Description No Response Can anyone assist the employee in performing the primary tasks assigned to this position? If yes, identify the eligible task(s) All of the abovePlease provide contact information for professional references.
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