Climbing: Mechanical lift, telephone, Occasionally copier, vehicle, fax, computer Reaching above head: Occasionally Sitting: Frequently Grasping: One hand: Standing: Frequently Frequently Walking: Frequently Both hands: Frequently Bending: Fine Manipulating: Frequently One hand: Occasionally Frequently Crawling: Both hands: Frequently Rarely Environmental Requirements Exposed to marked changes in temperature: Rarely Outside work: Occasionally Exposure to dust, fumes, odors, water, etc.: Frequently Exposure to biological, mechanical, electrical and/or chemical hazards: Frequently Normal (inside) environment: Continually Occasionally Sensory Requirements Eyesight: Normal/corrected: Necessary Close eye work: Necessary Other: _____________ Hearing: Normal tones: Necessary Soft Necessary Other: _____________ Distinguish Smells: Necessary Distinguish Temperatures: Touch: Necessary Proximity: Necessary
Mechanical lift, telephone, copier, vehicle, fax, computer Sitting: Frequently Standing: Frequently Walking: Frequently Bending: Frequently Occasionally Crawling: Rarely Climbing: Occasionally Reaching above head: Occasionally Grasping: One hand: Frequently Both hands: Frequently Fine Manipulating: One hand: Frequently Both hands: Frequently Environmental Requirements Exposed to marked changes in temperature: Rarely Outside work: Occasionally Exposure to dust, fumes, odors, water, etc.: Frequently Exposure to biological, mechanical, electrical and/or chemical hazards: Frequently Normal (inside) environment: Continually Occasionally Sensory Requirements Eyesight: Normal/corrected: Necessary Close eye work: Necessary Other: _____________ Hearing: Normal tones: Necessary Soft Necessary Other: _____________ Distinguish Smells: Necessary Distinguish Temperatures: Touch: Necessary Proximity: Necessary