PHYSICAL & COGNITIVE CHARACTERISTICS INVENTORY



INSTRUCTIONS: Indicate the characteristics that are necessary to perform the essential and marginal functions of the position. For each characteristic indicated, all of the associated essential and/or marginal functions must be listed in the Function #(s) column. DO NOT indicate an item if it is a preferred/common method (versus the only method) of performing a job function. For example, you would not want to indicate that an employee performing data entry needs to sit “C” (i.e., constantly) as that is the preferred or common method. The employee could accomplish the data entry working at a sit-stand desk.KEYN = NeverZero % of timeO = Occasionally1 – 33 % of timeUp to 2 ? hours1 – 33 repsF = Frequently34 – 66 % of time2 ? - 5 hours34 – 200 repsC = Constantly67 – 100 % of time5 – 8 hoursDescriptionFrequencyFunction #(s)NOFCSTAMINASitting (chair, stool, vehicle)Walking (distance 5’ to 100’)StandingSprinting/runningFLEXIBILITYBending or twisting at the neckBending or twisting the trunkCrouching/squatting/stooping/kneelingReaching above the headReaching forwardCrawling (e.g., under vehicle)ACTIVITIESClimbing (e.g., steps, ladders, into vehicles)Hand/grip strengthRepetitive motion (e.g., typing, calculator, stapling, stamping, filing, sorting, operating equipment, writing)Other: USE OF HANDS/ARMS/FEET (fingering/handling/wrist motions)Fingering (fine dexterity, picking, pinching)Handling (seizing, holding, grasping)Wrist motions (repetitive flexion/rotation)Feet (foot pedals)ADDITIONAL INFORMATION (e.g., extreme range of motion, eye-hand coordination, eye-hand-foot coordination, manual dexterity):LIFTINGIndicate the lifting levels required and the frequency of lifting each number of pounds.NOFCFunction #(s)0 – 5 lbs. FLOOR TO WAIST0 – 5 lbs. WAIST TO SHOULDER0 – 5 lbs. SHOULDER TO OVERHEAD6 – 9 lbs. FLOOR TO WAIST6 – 9 lbs. WAIST TO SHOULDER6 – 9 lbs. SHOULDER TO OVERHEAD10 – 25 lbs. FLOOR TO WAIST10 – 25 lbs. WAIST TO SHOULDER10 – 25 lbs. SHOULDER TO OVERHEAD26 – 50 lbs. FLOOR TO WAIST26 – 50 lbs. WAIST TO SHOULDER26 – 50 lbs. SHOULDER TO OVERHEAD51 – 75 lbs. FLOOR TO WAIST51 – 75 lbs. WAIST TO SHOULDER51 – 75 lbs. SHOULDER TO OVERHEAD76 or more lbs. FLOOR TO WAIST76 or more lbs. WAIST TO SHOULDER76 or more lbs. SHOULDER TO OVERHEADIf applicable, why are 76 or more lbs. lifted?If applicable, can loads/items over 50 lbs. be shared or reduced into small loads?N/ANeverSometimesUsuallyAlwaysPUSHING/PULLINGNOFCFunction #(s)0 – 5 lbs.6 – 9 lbs.10 – 25 lbs.26 – 50 lbs.51 – 90 lbs.Over 90 lbs.Frequency of pushing/pulling items on wheels?N/ANeverSometimesUsuallyAlwaysWhat types of terrain are items pushed/pulled on? (Check all that apply)CarpetTileConcreteBlacktop/pavementRough outdoor surfacesOther: CARRYINGNOFCFunction #(s)0 – 5 lbs.6 – 9 lbs.10 – 25 lbs.26 – 50 lbs.51 – 90 lbs.Over 90 lbs.If applicable, what distance are items over 50 lbs. carried? (Check all that apply)6 feet or less7 – 25 feet26 – 50 feetOver 50 feetMENTAL CAPABILITY/COGNITIVE REQUIREMENTSNOFCFunction #(s)Emotional/Behavioral Self-RegulationAbility to monitor, evaluate and modify one’s own emotional reactions (e.g., frustration)Ability to remain calm and focusedComprehensionUnderstand, remember and apply routine verbal and/or written instructionsUnderstand, remember and communicate routine, factual informationUnderstand complex problems and collaborate to explore alternative solutionsUnderstand opposing points of view on highly complex issues and to negotiate and integrate different viewpointsOrganizationOrganize thoughts and ideas into understandable terminologyOrganization activities to complete sequential and/or routine tasksOrganize and prioritize individual work schedule to manage multiple tasks and/or projectsOrganize and prioritize the work schedule of others to manage multiple tasks and/or projectsNOFCFunction #(s)Decision makingMake decisions that have an impact on the individual’s workMake decisions that have an impact on the immediate work unit’s operations and servicesMake decisions that have an impact on the agency’s credibility, operations and/or servicesCommunication (e.g., verbal, writing)Communicate and exchange routine/basic informationCommunicate and explain a variety of informationCommunicate in-depth information for the purpose of interpreting and/or negotiatingIn person (or through communication media) presentation(s) to groupsMathematicsCount accuratelyAdd, subtract, multiply and divideCompute, analyze and interpret numerical data for reporting purposesCompute, analyze and interpret complex statistical data and/or to develop forecasts and/or computer modelsVISIONSeeing objects/persons at a distance, for example: when drivingSeeing close work such as typed or handwritten materialBeing able to tell differences among colorsHaving very good depth perceptions (fine muscle control)Stereoscopic visionHEARINGHearing conversation in a quiet environmentHearing conversation in a noisy environmentAbility to tell where a sound is coming fromHearing differences among bells, buzzers, beeps, horns, etc.SPEECH/COMMUNICATIONCommunicating through speech (Communication skills required to converse with customers and co-workers)QUOTAS/WORK SPEEDHigh volume of piecework, provide standard:High work speed required meeting quotas, provide standard:Process multitasking work and changing/transitional workNOFCFunction #(s)WORKING CONDITIONSWorking insideWorking outsideWorking in temperatures below 32 degrees FahrenheitWorking in temperatures above 100 degrees FahrenheitWorking where there are sudden temperature changes (changes of greater than 50 degrees Fahrenheit)Walking on slippery surfacesBeing soaking wetWorking over 6 feet off the groundWorking in confined and/or cramped spacesWorking in loud noise areas (where the employee would have to raise his or her voice to be heard)Exposure to welding flash or microwaves while doing the jobClose exposure to computer monitors and video screensExposure to sunlightExposure to fluorescent lightHandling or being in machinery that is vibrating (commercial motor vehicles)Working where there are sudden changes in air pressure, or very high or low air pressureRisk of getting a minor injury (minor cut, bruise, scrape, burn)Risk of getting a major injury (broken bone, major burn, deep cut, shot, etc.)Risk of being bitten by animals or insectsExposure to silica or asbestos dust (cement or concrete powder), is there enough of this dust that the employee needs to wear a mask?Exposure to other types of dust, other than ordinary surface or household dust, is there enough of this dust that the employee needs to wear a mask?Exposure to environmental allergens (grasses, weeds, pollens, trees)Exposure to infection (germs, bacteria, viruses, etc.) This question refers to a risk greater than the risk to the average personExposure to x-rays or radioactive isotopesContact with oils or other petroleum productsExposure to solvents, degreasers, pesticides and/or herbicidesExposure to gases, fumes, sprays, etc.Meeting deadlinesInteracting with the public, other workers, etc.NOFCFunction #(s)Irregular or extended work hours, explain (e.g., shift, mandatory overtime):Working alone (not within shouting distance of others)Direct responsibility for the safety, well-being, or work output of other peopleMultiple demands from several peopleHandle general office chemicals (toner, ink pads, disinfectant, lubricants (WD 40), bleach, fire extinguisher compound, etc.) Exposure to traffic hazard(s)Ventilation and air quality (This is applicable when required to work in poor ventilation and the risk is greater than the risk to the average person per the Occupational Safety and Health Administration, this does not refer to a general office situation)PERSONAL PROTECTIVE EQUIPMENTMaskFilter respiratorRespirator (similar to SCUBA tank setup)Goggles or safety glassesGlovesHard hatChapsEar plugs/muffsLead apronFace shieldSteel-toed shoesChemical apronBody suitCheck if applicableDrivingLength of time per day (e.g., hours, minutes): Commercial drivers’ license basic skills testPeace Officers Standards and Training (POST) annual training requirementsOther: ................
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