☐ Never ☐ Occasionally ☐ Constantly
Moving self in different positions to accomplish tasks in various environments including tight and confined spaces.
☐ Never ☐ Occasionally ☐ Constantly
Remaining in a stationary position, often standing or sitting for prolonged periods.
☐ Never ☐ Occasionally ☐ Constantly
Moving about to accomplish tasks or moving from one worksite to another.
☐ Never ☐ Occasionally ☐ Constantly
Adjusting or moving objects up to __ pounds in all directions.
☐ Never ☐ Occasionally ☐ Constantly
Communicating with others to exchange information.
☐ Never ☐ Occasionally ☐ Constantly
Repeating motions that may include the wrists, hands and/or fingers.
☐ Never ☐ Occasionally ☐ Constantly
Operating machinery and/or power tools.
☐ Never ☐ Occasionally ☐ Constantly
Operating motor vehicles or heavy equipment.
☐ Never ☐ Occasionally ☐ Constantly
Assessing the accuracy, neatness and thoroughness of the work assigned.
☐ Never ☐ Occasionally ☐ Constantly
Environmental Conditions
Low temperatures.
☐ Never ☐ Occasionally ☐ Constantly
High temperatures.
☐ Never ☐ Occasionally ☐ Constantly
Outdoor elements such as precipitation and wind.
☐ Never ☐ Occasionally ☐ Constantly
Noisy environments.
☐ Never ☐ Occasionally ☐ Constantly
Hazardous conditions.
☐ Never ☐ Occasionally ☐ Constantly
Poor ventilation.
☐ Never ☐ Occasionally ☐ Constantly
Small and/or enclosed spaces.
☐ Never ☐ Occasionally ☐ Constantly
No adverse environmental conditions expected.
☐ Never ☐ Occasionally ☐ Constantly
Physical Demands
Sedentary work that primarily involves sitting/standing.
☐ Never ☐ Occasionally ☐ Constantly
Light work that includes moving objects up to 20 pounds.
☐ Never ☐ Occasionally ☐ Constantly
Medium work that includes moving objects up to 50 pounds.
☐ Never ☐ Occasionally ☐ Constantly
Heavy work that includes moving objects up to 100 pounds or more.
☐ Never ☐ Occasionally ☐ Constantly
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