| Agency_________ Position___________ Salary______ Reference________ | ||||
|---|---|---|---|---|
| 1. Job Description (Attach additional sheets) |
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| 2. Physical Req'ments | Weight/Reach | % of Time | Adaptations | Remarks |
| Carrying | . | . | . | . |
| Cleaning | . | . | . | . |
| Climbing | . | . | . | . |
| Collating | . | . | . | . |
| Dialing | . | . | . | . |
| Driving | . | . | . | . |
| Filing | . | . | . | . |
| Hearing | . | . | . | . |
| Holding | . | . | . | . |
| Indexing | . | . | . | . |
| Inserting | . | . | . | . |
| Lifting | . | . | . | . |
| Maintaining | . | . | . | . |
| Opening | . | . | . | . |
| Pulling | . | . | . | . |
| Pushing | . | . | . | . |
| Removing | . | . | . | . |
| Scheduling | . | . | . | . |
| Sitting | . | . | . | . |
| Sorting | . | . | . | . |
| Speaking | . | . | . | . |
| Stamping | . | . | . | . |
| Standing | . | . | . | . |
| Stapling | . | . | . | . |
| Threading | . | . | . | . |
| Turning Pages | . | . | . | . |
| Typing | . | . | . | . |
| Unfolding | . | . | . | . |
| Unlocking | . | . | . | . |
| Using Keyword | . | . | . | . |
| Walking | . | . | . | . |
| Weighing | . | . | . | . |
| Writing | . | . | . | . |
| 3. Cognitive | Requirements | Level/Type | Recommendations | |
| Education | . | . | . | |
| Math | . | . | . | |
| Problem Solv'g | . | . | . | |
| Reading | . | . | . | |
| Reasoning | . | . | . | |
| Training | . | . | . | |
| 4. Site Evaluation | Dimensions | Adaptations | ||
| Job Site | ||||
| Desk | . | . | ||
| Door | . | . | ||
| Door Mechanism | . | . | ||
| Elevators | . | . | ||
| Entrance | . | . | ||
| File Cabinets | . | . | ||
| Floor Covering | . | . | ||
| Obstacles | . | . | ||
| Steps | . | . | ||
| Threshold | . | . | ||
| Bathroom | ||||
| Door | . | . | ||
| Grab Bars | . | . | ||
| Sink | . | . | ||
| Toilet | . | . | ||
| Cafeteria | ||||
| Accessibility | . | . | ||
| Parking | . | . | ||
| 5. Comments: Operation of Equipment |
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_______________________________ __________________ Job Analyst Date