Agency Position            Salary Reference

 

 

1. Job Description

 

 

 

 

 

2. Physical Requirements  Weight/Reach   % of Time Adaptations Remarks

 

 

Carrying

Cleaning

Climbing

Collating

Dialing

Driving

Filing

Hearing

Holding

Indexing

Inserting

Lifting

Maintenance

Opening

Pulling

Pushing

Removing

Scheduling

Sitting

 

 

2. Physical Requirements Weight/Reach   % of Time      Adaptations      Remarks

 

Sorting

Speaking

Stamping

Standing

Stapling

Threading

Turning Pages

Typing

Unfolding

Unlocking

Using Keyboard

(coding)

Walking

Weighing

Writing

 

3. Cognitive Requirements          Level/Type                         Recommendations

 

Education

Math

Problem Solving

Reading

Reasoning

Training

 

4. Site Evaluation       Dimensions Adaptations

 

 

Job Site

Desk

 

4. Site Evaluation Dimensions Adaptations

 

 

Door

Door Mechanism

Elevators

File Cabinets

Floor Covering

Obstacles

Steps

Threshold

Bathroom

Door

Grab Bars

Sink

Toilet

Cafeteria

Accessibility

Parking

 

5. Comments:

Operation of Equipment

 

Job Analyst Date

 

 

Reprinted with permission from the Job Development Bank and Enhanced Productivity for Severely Disabled Persons, K. Mallik and S. Yuspeh, 1979, G. Washington University Rehabilitation Research and Training Center, Washington, D.C., Grant # G008300123, NIDRR, Department of Education