(Pick the one from each category that best suits this position):
Physical Effort:
___Average physical effort with some handling of light weights such as
supplies or materials on an infrequent basis. (10 – 15 lbs.)
___ Occasionally an above average amount of physical effort including
consistent standing, lifting and carrying light to moderately heavy
materials or equipment.
__x_ High level of physical effort such as pushing, pulling, bending, lifting
and carrying heavy objects. (Over 50 lbs.)
Visual:
___ Average visual effort with infrequent exposure to visually demanding
work.
__x_ Above average visual effort with frequent exposure to visually
demanding work involving detailed work.
___ High level of visual effort with continuous exposure to highly detailed
work requiring substantial concentration.
What is the extent of exposure to unpleasant work conditions required in carrying out job duties? Check Only One from each category.
__x_ Work performed in an environment with correctable conditions such
as lighting and room temperature.
___ Work performed in an environment requiring occasional exposure to
weather extremes, fumes , odors and/or noise.
___ Work performed in an environment requiring constant exposure to
weather extremes, fumes, odors and/or loud noise
Hazards:
__x_ Normally, no exposure to job hazards; probability of injury is remote.
___ Occasional exposure to job hazards, resulting in some injury, lost time,
or threatening to one’s personal health.
___ Frequent exposure to job hazards, resulting in injury, lost time, total
disability or death.
