LIFTING Indicate the lifting levels required and the frequency of lifting N O F C Function #(s) each number of pounds. 0 5 lbs. FLOOR TO WAIST – 0 5 lbs. WAIST TO SHOULDER – 0 5 lbs. SHOULDER TO OVERHEAD – 6 9 lbs. FLOOR TO WAIST – 6 9 lbs. WAIST TO SHOULDER – 6 9 lbs. SHOULDER TO OVERHEAD – 10 25 lbs. FLOOR TO WAIST – 10 25 lbs. WAIST TO SHOULDER – 10 25 lbs. SHOULDER TO OVERHEAD – 26 50 lbs. FLOOR TO WAIST – 26 50 lbs. WAIST TO SHOULDER – 26 50 lbs. SHOULDER TO OVERHEAD – 51 75 lbs. FLOOR TO WAIST – 51 75 lbs. WAIST TO SHOULDER – 51 75 lbs. SHOULDER TO OVERHEAD – 76 or more lbs. FLOOR TO WAIST 76 or more lbs. WAIST TO SHOULDER 76 or more lbs. SHOULDER TO OVERHEAD If applicable, why are 76 or more lbs. lifted? If applicable, can loads/items over 50 lbs. be shared or reduced N/A into small loads? Never Sometimes Usually Always PUSHING/PULLING N O F C Function #(s) 0 5 lbs. – 6 9 lbs. – 10 25 lbs. – 26 50 lbs. – 51 90 lbs. – Over 90 lbs. Frequency of pushing/pulling items on wheels? N/A Never Sometimes Usually Always
LIFTING Indicate the lifting levels required and the frequency of lifting each number of pounds. N O F C Function #(s) 0 – 5 lbs. FLOOR TO WAIST 0 – 5 lbs. WAIST TO SHOULDER 0 – 5 lbs. SHOULDER TO OVERHEAD 6 – 9 lbs. FLOOR TO WAIST 6 – 9 lbs. WAIST TO SHOULDER 6 – 9 lbs. SHOULDER TO OVERHEAD 10 – 25 lbs. FLOOR TO WAIST 10 – 25 lbs. WAIST TO SHOULDER 10 – 25 lbs. SHOULDER TO OVERHEAD 26 – 50 lbs. FLOOR TO WAIST 26 – 50 lbs. WAIST TO SHOULDER 26 – 50 lbs. SHOULDER TO OVERHEAD 51 – 75 lbs. FLOOR TO WAIST 51 – 75 lbs. WAIST TO SHOULDER 51 – 75 lbs. SHOULDER TO OVERHEAD 76 or more lbs. FLOOR TO WAIST 76 or more lbs. WAIST TO SHOULDER 76 or more lbs. SHOULDER TO OVERHEAD If applicable, why are 76 or more lbs. lifted? If applicable, can loads/items over 50 lbs. be shared or reduced into small loads? N/A Never Sometimes Usually Always PUSHING/PULLING N O F C Function #(s) 0 – 5 lbs. 6 – 9 lbs. 10 – 25 lbs. 26 – 50 lbs. 51 – 90 lbs. Over 90 lbs. Frequency of pushing/pulling items on wheels? N/A Never Sometimes Usually Always
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