If any of the functions(1-5) are infrequent but essential, please indicate with (E).
Note: Consistent and reliable attendance is an essential function of all positions.

Position Title:


(Please check the box beside each mental function that best describes this position.)

not-required infrequent frequent not-required infrequent frequent
Comparing Copying
Computing Compiling
Analyzing Coordinating
Synthesizing Negotiating
Communicating Instructing
Interpersonal Skills/Behavior

Mental Functions -- Definitions

  1. Comparing-Judging the readily observable functional, structural, or compositional characteristics (whether similar to or divergent from obvious standards) of data, people, or things.
  2. Copying-Transcribing, entering, or posting data.
  3. Computing-Performing arithmetic operations and reporting on and/or carrying out a prescribed action in relation to them.
  4. Compiling-Gathering collating, or classifying information about data, people or things. Reporting and/or carrying out a prescribed action in relation to the evaluation is frequently involved.
  5. Analyzing-Examining and evaluating data. Presenting alternative actions in relation to the evaluation is frequently involved.
  6. Coordinating-Determining time, place, and sequence of operations or action to be taken on the basis or analysis of data. May include prioritizing multiple responsibilities and/or accomplishing them simultaneously.
  7. Synthesizing-To combine or integrate data to discover facts and/or develop knowledge or creative concepts and/or interpretations.
  8. Negotiating-Exchanging ideas, information, and opinions with others to formulate policies and programs and/or jointly arrive at decided, conclusions, solutions, or solve disputes.
  9. Communicating-Talking with and/or listening and/or signaling people to convey or exchange information; includes giving/receiving assignments and/or directions.
  10. Instructing-Teaching subject matter to others or training others through explanation, demonstration, and supervised practice; or making recommendations on the basis of technical disciplines.
  11. Interpersonal Skills/Behaviors-Dealing with individuals with a range of moods and behaviors in a tactful, congenial, personal manner so as not to alienate or antagonize them.


(Please check the box that best describes the physical demands of this position.)

less than .25 from .25 to .50 more than .50 less than .25 from .25 to .50 more than .50
not-required of typical day of typical day of typical day not-required of typical day of typical day of typical day
Standing Walking
Sitting Climbing
Balancing Stooping
Kneeling, Crouching, Crawling Reaching
Handling, Fingering, Feeling Talking
Hearing Control of Others

Physical Demands Definitions
  1. Climbing- Ascending or descending using feet and legs and/or hands and arms. Body agility is emphasized.
  2. Balancing- maintaining body equilibrium to prevent falling on narrow, slippery or erratically moving surfaces, or maintaining body equilibrium when performing feats of agility.
  3. Stooping- Bending body downward and forward. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.
  4. Kneeling, Crouching and Crawling:
    • Kneeling- Bending legs at knees a\to come to rest on knee or knees.
    • Crouching- Bending downward and forward by bending legs and spine.
    • Crawling- Moving about on hands and knees or hands and feet.
  5. Reaching- Extending hand(s) and arm(s) in any direction.
  6. Handling, Fingering, and Feeling:
    • Handling- Seizing, holding, grasping, turning, or otherwise working with hand or hands.
    • Fingering- Picking, pinching, or otherwise working primarily with fingers rather than with the whole hand or arm as in handling.
    • Feeling- perceiving attributes of objects, such as size, shape, temperature, or texture, by touching with skin, particularly that of fingertips.
    • Talking- Expressing or exchanging ideas by means of the spoken word. Talking is important for those activities in which workers must impart oral information to clients or to the public, and in those activities in which they convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
  7. Hearing- perceiving the nature of sounds. Used for those activities which require ability to receive detailed information through oral communications, and to make fine discriminations in sounds, such as when making fine adjustments on running engines
  8. Control of Others- seizing, holding, controlling, and/or otherwise subduing, violent, assaultive, or physically threatening persons to defend oneself or prevent injury. Body strength and agility of all four limbs is necessary.



required not required never sometimes often always
Near Acuity-clarity of vision at 20 inches or less. Up to 10 pounds
Far Acuity - clarity of vision at 20 feet or more. Up to 25 pounds
Depth Perception - three dimensional vision. Up to 50 pounds
Accommodation - Adjustment of eyes to bring things into clear focus. Close work. Up to 100 pounds
Color Vision - Ability to identify and distinguish colors. More than 100 pounds


Please check the box which best describes the environmental conditions encountered in this position in a typical day.
never sometimes often always
Exposure to Extreme Weather
Extreme Cold Non-Weather related
Extreme Heat Non-Weather related
Wet and/or Humid
Atmospheric Conditions
Confined/Restricted Working Environment

Environmental Conditions Definitions

  1. Exposure to Extreme Weather>-Exposure to hot, cold, wet, humid, or windy conditions caused by the weather.
  2. Extreme Cold Non-Weather related- Exposure to nonweather related cold temperatures.
  3. Extreme Heat Non-Weather related- Exposure to nonweather related hot temperatures.
  4. Wet and/or Humid- contact with water or other liquids; or exposure to nonweather related humid conditions.
  5. Atmospheric Conditions- Exposure to conditions such as fumes, noxious odors, dusts, mists, gases, and poor ventilation, that affect the respiratory system, eyes or the skin.
  6. Hazards-Exposure to situations with a definite risk of bodily injury, such as, proximity to moving mechanical parts, electrical current, working on scaffolding and high places, explosives, radiations, chemicals.
  7. Vibration- Exposure to a shaking object or surface. This is factor rated important when vibration causes a strain on the body or extremities.
  8. Confined/Restricted Working Environment- Work is performed in a closed or locked facility providing safety and security for clients or fellow workers.


check box
Very Quiet (forest trail, isolation booth for hearing test)
Very Quiet (forest trail, isolation booth for hearing test)
Quiet (library, private office)
Loud Noise (lawn mowing or large earth moving equipment
Very Loud Noise (jack hammer work)