OVERALL PHYSICAL STRENGTH DEMAND
PHYSICAL DEMANDS
F
Standing
F
Sitting
O
Walking
O
Lifting
O
Carrying
O
Pushing/Pulling
R
Reaching
R
Handling
C
Fine Dexterity
R
Kneeling
R
Crouching
R
Crawling
R
Bending
R
Twisting
N
Climbing
R
Balancing
C
Vision (Correction Required: N/A )
F
Hearing
F
Talking
O
Foot Controls (driving, operation of equip, etc.)
ENVIRONMENTAL FACTORS
N
Mechanical Hazards
N
Dirt and Dust
N
Chemical Hazards
N
Extreme Temperatures
R
Electrical Hazards
R
Noise and Vibration
N
Fire Hazards
N
Fumes and Odors
N
Explosives
N
Wetness/Humidity
N
Communicable Diseases
N
Darkness or Poor Lighting
N
Physical Danger or Abuse
Other (specify)
PRIMARY WORK LOCATION
Office Environment
MACHINES, TOOLS, EQUIPMENT, WORK AIDS
PROTECTIVE EQUIPMENT REQUIRED
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