Document zbLJVjOD7y30b4dpGn3ZR3ga3

1 JOB ANALYSIS FOR PHYSICAL FITNESS REQUIREMENTS r --" NAME AMO LOCATION OF ESTABLISHMENT AOCNCY GRADE Does establishment have medical uipemiica to thefe aa indostnil safety bnad) Q Yes Yes Q No Q No gefer to the manual for /eb analytet before uung tbit fora. Cheek all functional and narking condition factort at veil at acceptable ditabihtie* whenever appropriate. 1. FUNCTIONAL FACTORS L * Little M - tfodMe G - Greet 0 - None Hands FImni 3EG3 Anas L-C0 Lns Fas* 1 LM L RncU^ X Poshing or pclUag 3 HadUag . Fingering B. Hatching 9. Lifting 10. PotUag or pdiinf " 1L Cmrytag 14. Walking or n*aiag is. auadiac 16. Sitting 17 Carrying 9. CUolaag 12. CUaddng IS. Climbing 6k TUowing 7. Touching 13. Tfcrowiae [Ext. 19. jMtSn. 20k Ttxniag 30 Near mia 2L Ufliag 1 Vole. 3L Far vision |. Tlkln.INI 32. Color vision jII. WORKING CONDITION FACTORS ____________ i 111 Bs^y - Tnmk 22. Sitting 23. Bending 24. Reaching 25 Lifting 26k Cavrytag 27. Jumping 23 Turning 3233, i \ " L __________________________________ J 34. Inside 35 Oataids 3ft. High elevations cp3!5laS"lr "" " 36. High Mapmist 39k Lear tsapsrstve " " :40. Saddsn Iwyawtart 4L High humidity 42. Lae humidity 43k Wataaaa 44 Air praati-- 45. Noise 46. Vibration 47 Oily _ . Odors 49 Body iqKvbs 50. Bums 9L Blactiicai hasaids 52. explosives S3 Slippery swfeces 54. Radlsftf easrer 55. Toxic conditiooa 56. Icdoctioos 57. Dust -- - - 56. Silica dust 59. Moving obtecta 60 Touting with Jj r III}. ACCEPTABLE DISABILITIES | A Aapatrttan 0 * Dtaabtbty Y Yem Check appropriate equate if acceptable N * Ho I | Hoads Fimn 1 or 3 on primary head 1 m 2 oa ascoodary had Mgsjhaa 3 on primary Harjhn 2 on secondary & Hoad 02 Hoad* Nm Eros DU ad ladustvtsUy blind Uliad oa eye Color bUod Color bUad for shades A 0 Anas D Lns foot 1 Arm 1 Leg (Ugh) 2 Arms itc Q 2 Lags (Ugh) - " 1 Leg (low) 2 Lege (low) - 1 Foot - 2 Foot None Q f J __________________________________ Ears LU Desf Cmdio Vascular Ksrd at hasting, 1 ar - Hard of hearing, 2 ears L Hearts* aid acceptsbla | Moderate teas!on - High tension ] Organic heart disease compensated ft D Body - Tnmk 1 tftp 2 Hips 1 Shoulder 2 Shoulders Bhck | 1 - 0 - __________________________________ Tubercolosis YM l N TBassn^arrara-- ModmraieVtesledr stable - table or arrested) Collapse therapy -- Fic 21-9 --Form used by U S Civil Service Commission to facilitate placement of the handicapped worker in a productive environment 565