Appendix B 

JOB ANALYSIS

 

Company Name: ___________________________________________________________

Type of Service/Employment : _______________________________________________

Job Title: _________________________________________________________________

Job Duties: 

 

 

 

 

Job Skills Needed:

 

 

 

 

Hourly wage (range) ____________________

 

Number of Hours/ week: _____ Months/Year (seasonal) ___________________________ 

 

Employer’s               Tax Credits                      Other:

Financial                 

Requirements:                     (e.g. TJTC, OJT)_______________

Benefits of Job:

Yes / No                    None                                      Yes / No        Free or Reduced Meals

Yes / No                    Sick Leave                            Yes / No       Other (Specify):

Yes / No                    Medical/Health Benefits

Yes / No                    Paid Vacation/Annual Leave

Yes / No                    Dental Benefits

Yes / No                    Employee Discounts          Yes / No                    Flex time

Employer      Very Supportive    Supportive       Indifferent to          Negative toward

Attitude:        of Older Workers     with                   Workers with           Workers with

With Disabilities__   Reservations__ Disabilities___        Disabilities____

Specifics/Comments:

Accessibility of Job Site:                           Condition                 Accommodations

 

Steps/Ramping

 

Flooring

 

Water fountain

 

Bathroom 

 

Elevators/Escalators

 

Cafeteria

 

Lighting in the facility

 

Task lighting

 

General lighting

 

Work area accommodations

 

Assistive technology available

 

Physical barriers

 

Noise levels

 

Temperature regulation

 

Environmental pollutants

 

General Directions:

Indicate the most appropriate response for each item based on observations of the job and interviews with employers, supervisors, and coworkers.

1. Schedule:             Weekend Work       Evening Work         Part-time Job              Full-Time Job

    (Circle Yes or       Required                   Required                  

     No for each

     Item)                     Yes / No                    Yes / No                    Yes / No           Yes / N

Specifics/Comments

  2.  Travel Location:                                    On Public                              On Handicapped

     (Circle Yes or No for                 Transportation                    Transportation Route

       each item                                 Route

 

Yes / No                                Yes / No

Specifics/Comments

3.    Street                 Must Cross                Must Cross                Must Cross    Must Cross

       Crossing:            2 Lane                       2 Lane                       4 Lane           4 Lane

Street with               Street W/O              Street with   Street W/O

Light_____                 Light_____                 Light_____     Light_____

Specifics/Comments (alone or with help?)

 

4.  Strength:             Very Light                 Light                           Average           Heavy

     Lifting and           Work                           Work                           Work                   Work

     carrying:              (10 lbs)___                 (10-20 lbs)___           (30-40 lbs)___   (>50  lbs)__

Note frequency:

Specifics/Comments

 

5.  Endurance:        Work Required        Work Required    Work Required    Work Required

                                    for 2 hours___           for 2-3 hours___  for 3-4 hours___  For >4 hours__

 

Specifics/Comments

 

6.  Orienting:                        Small Area               One        Several        Building       Building and

Only_____                 Room___Rooms___ Wide____     Grounds

 

 

Specifics/Comments

 

7.  Physical                Sit/Stand in one     Fair Ambulation     Stairs/Minor         Full Physical

     Mobility                Area_____                Required_____         Obstacles_____      Requirements__

 

 

Specifics/Comments

 

8.  Work Pace          Slow               Average Steady    Sometimes Fast      Continual Fast

Pace____      Pace_____                Pace_____                Pace_____

 

 

Specifics/Comments

9.  Standing             Hours per day_________                Surface______________________

 

 

Specifics/Comments (is sitting an option?)

 

10.  Grasping/Reaching__________      Strength required ___      Frequency __________

 

 

Specifics/Comments (can extension be used?)

 

11. Bending

Frequency

Specifics/Comments

 

 

12.  Object                    Does not need to         Must Distinguish               Must distinguish

       Discrimination:      Distinguish Between    Between Work Supplies    Between Work

     Work Supplies_____       with an External Cue___    Supplies_____

 

Specifics/Comments

 

13.  Reading            None     Printed forms        Handwritten documents              Computer   Braille

  screens      Required

Specifics/Comments (is worker reading to others?)

 

14.  Writing               Method:                   hand writing        typing                            braille

       Required            Type:                           Forms___          Messages___                   Reports__

Specifics/Comments (is worker writing for self or others?)

 

 

15.  Tool                     Calibrations___       Positioning                Measurement         General

       Utilization__                                          & guiding___                       marking___              safety___

 

 

Specifics/comments (provide own tools?)

 

 

16.  Machine                       Reading dials                                  Buttons &

       Operation         LED/LCD displays___                      other controls ___ 

Specifics/comments (speed required?)

 

 

17.  Skills Needed                Manual Dexterity___         Visual Tasks___        Auditory Tasks_

(Physical Demands)

Specifics/comments

 

 

18.  Communication   Talking in person_  Talking on the phone   Using keyboard__  Taking

               Skills                                      or using switchboard__                       Messages__

(Need for hearing aid, assistive listening devices, interpreter)

Specifics/comments

 

 

19.  Computer skills using keyboard      Seeing or accessing  monitor     Need for speech or braille output

Knowledge of Windows__  Data processing skills__    Word processing skills__

 

 

Specifics/comments (note speed/ accuracy needed on keyboard)

20.  Other job skills/abilities needed:

 

Multi-tasking___     Meeting deadlines___    Working with groups   Memorization___

 

Other___

 

 

Specifics/comments

 

 

Summary of job analysis:

 

 

 

Summary of modifications needed:

 

 

 

Staff Name: __________________        Title___________________ Date_________

 End of Job Analysis Form.

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[Introduction] [Pre-Test] [ Module 1] [Module 2] [Module 3] [Module 4] [Module 5] [Module 6] [Module 7] [Post Test]

[Appendix A] [Appendix B] [Appendix C] [Appendix D] [Appendix E] [Appendix F] [Appendix G] [Appendix H]

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