Essential Functions Worksheet



|Essential Functions Worksheet |

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|Job Classification:       Department:       |

|Incumbent Name:       |

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|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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