Sample: Job Task Analysis Form - OSACH
Sample Job Task Analysis Form
A Job Task Analysis should be completed for each task in a job.
All completed Job Task Analysis (JTA) forms should be kept in a central location so they can be accessed by management when conducting training on the task.
|Job Title: | |
|Name of Task: | |
|Supervisor: |Hours Worked per Week: |
|Outline of Job Duties: | |
| | |
| | |
| | |
| | |
|Physical Job Demands | |
|Grade activity frequency according to scale below by circling the most appropriate number on the following form. |
|0 - not required |3 - occasionally required (12-25 times/shift) |
|1 - seldom required (1-5 times/shift) |4 - frequently required (26-70 times/shift) |
|2 - minor requirements (6-11 times/shift) |5 - always required (71+ times/shift) |
| | |
|Where applicable, grade weight requirements according to scale below by circling the most appropriate lower case letter. |
|a- limited (up to 5 kg) |c - medium (10 kg but less than 20 kg) |
|b- light (5 kg but less than 10 kg) |d - heavy (more than 20 kg) |
| | |
|Grade activity duration according to the scale below by circling the most appropriate upper case letter on the following form. |
|A - minimal (0 to 1 hour/shift) |D - continuous (over 5.5 hours/shift) |
|B - occasional (1 - 2.5 hours/shift) |C - frequently (2.5 - 5.5 hours/shift) |
| |E - never |
|Comments section should identify mechanical or physical aids recommended or required as well as any additional information pertaining to the |
|physical activity being performed. |
Note: Job Task Analyses should be completed on all jobs within your company.
[This form has 3 pages]
|Physical Activity |Specification |Frequency |Weight |Duration |Comments |
|BENDING |at waist |0 1 2 3 4 5 | |A B C D E | |
| |stooping |0 1 2 3 4 5 | |A B C D E | |
| |kneeling |0 1 2 3 4 5 | |A B C D E | |
| |crouching |0 1 2 3 4 5 | |A B C D E | |
| |crawling |0 1 2 3 4 5 | |A B C D E | |
| |squatting |0 1 2 3 4 5 | |A B C D E | |
|WALKING |level surface |0 1 2 3 4 5 | |A B C D E | |
| |rough ground |0 1 2 3 4 5 | |A B C D E | |
| |slopes |0 1 2 3 4 5 | |A B C D E | |
| | | | | | |
|CLIMBING |stairs |0 1 2 3 4 5 | |A B C D E | |
| |ladders |0 1 2 3 4 5 | |A B C D E | |
| | | | | | |
|SITTING |chair |0 1 2 3 4 5 | |A B C D E | |
| |stool |0 1 2 3 4 5 | |A B C D E | |
| |vertical seat |0 1 2 3 4 5 | |A B C D E | |
| | | | | | |
|STANDING | |0 1 2 3 4 5 | |A B C D E | |
| | | | | | |
|BALANCING | |0 1 2 3 4 5 | |A B C D E | |
| | | | | | |
|REACHING |overhead |0 1 2 3 4 5 | |A B C D E | |
| |forward |0 1 2 3 4 5 | |A B C D E | |
| |side |0 1 2 3 4 5 | |A B C D E | |
| | | | | | |
|NECK POSTURES |flexion |0 1 2 3 4 5 | |A B C D E | |
| |extension |0 1 2 3 4 5 | |A B C D E | |
| |rotation |0 1 2 3 4 5 | |A B C D E | |
| |side flexion |0 1 2 3 4 5 | |A B C D E | |
| | | | | | |
|SHOULDER |abduction |0 1 2 3 4 5 | |A B C D E | |
| | | | | | |
|POSTURE |flexion |0 1 2 3 4 5 | |A B C D E | |
| | | | | | |
|WRIST |flexion |0 1 2 3 4 5 | |A B C D E | |
| | | | | | |
|POSTURE |extension |0 1 2 3 4 5 | |A B C D E | |
| | | | | | |
|HANDLING |fine manipulation |0 1 2 3 4 5 |a b c d |A B C D E | |
| |gross manipulation |0 1 2 3 4 5 |a b c d |A B C D E | |
| |hand tool usage |0 1 2 3 4 5 |a b c d |A B C D E | |
| | | | | | |
|LIFTING |from ground |0 1 2 3 4 5 |a b c d |A B C D E | |
| |from bench |0 1 2 3 4 5 |a b c d |A B C D E | |
| |over shoulder |0 1 2 3 4 5 |a b c d |A B C D E | |
| |over head |0 1 2 3 4 5 |a b c d |A B C D E | |
| | | | | | |
|CARRYING | | |a b c d |A B C D E | |
| | | | | | |
|PUSHING | | |a b c d |A B C D E | |
| | | | | | |
|PULLING | | |a b c d |A B C D E | |
| | | | | | |
|WRITING | |0 1 2 3 4 5 | |A B C D E | |
| | | | | | |
|TYPING | |0 1 2 3 4 5 | |A B C D E | |
ENVIRONMENTAL CONDITIONS:
|Indoor/ Outdoor (circle one of both) |Temperature (average) |
|Noise level (approximate) |Required Safety Equipment |
|Dust/Mist/Vapour/Gas (yes or no) |Equipment/Tools Used |
Notes:
|Completed by: |Position: |
| | |
|Date Completed: | |
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