Essential Functions Worksheet
|Essential Functions Worksheet |
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|Job Classification: Department: |
|Incumbent Name: |
| |
|Title of Person Completing Worksheet: Name: Date: |
|SUPERVISOR REVIEW |
|(Managers & Supervisors only) |
|Form Completion: |Time Spent. |Supervisor Review |
|List tasks below as required for the position, utilize class spec and job requirements. |Will total 100%. | |
|Define Time Spent. | |E – Major focus of |
|Define Major/Minor focus of position. |Provide best estimate of|job/position |
|Define the Physical Ability Requirements and Working Environment of the position. |percent of work year | |
|Review with Human Resources. |spent performing each |NE - Minor (easily |
| |task listed. |assigned to another |
| | |person) |
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|Physical Ability Requirements and Working Environment: |
|Use the categories below to complete the “Time Spent” and “Frequency” columns for those Physical activities and Working Environments experienced on your job. |
| TIME SPENT COLUMN FREQUENCY COLUMN |
|S - Significant = 25% or more O - Occasional = 5% or less D - Daily M - Monthly N - Never |
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|M - Moderate = 6-24% N - Never W - Weekly O - Occasionally |
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|Physical Activity |Time Spent |Frequency | |Working Environment |Time Spent |Frequency |
|Sitting | | | |Extreme Cold | | |
|Standing | | | |Extreme Heat | | |
|Walking | | | |Extreme Noise | | |
|Running | | | |Working Outdoors | | |
|Kneeling | | | |Vibration | | |
|Pushing | | | |Confining Work Space | | |
|Pulling | | | |Chemicals | | |
|Bending/Crouching/Stooping/Squatting | | | |Explosive Materials | | |
|Crawling | | | |Mechanical Hazards | | |
|Twisting Upper Body | | | |Electrical Hazards | | |
|Climbing | | | |Dust, Dirt, Grease | | |
|Driving | | | |Infectious Disease | | |
|Lifting: | | | |Use Protective Devices | | |
|specify minimum: lbs. | | | |(masks, goggles, gloves, | | |
|specify maximum: lbs. | | | |etc. ) | | |
|Use of tools requiring dexterity | | | |Other | | |
|Distinguish between colors | | | | | | |
|Other | | | | | | |
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