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Date:  _ /_ /_____

PURDUE UNIVERSITY

MENTAL, PHYSICAL, AND ENVIRONMENTAL

POSITION SPECIFICATION FORM

The purpose of this form is to identify and document the mental and
physical demands and the environmental factors required for administrative/professional
and clerical/service positions.

If the position is being revised or updated, the incumbent should
complete the form, if the position is new, it should be completed by
the supervisor.

Identify only those physical requirements and mental skills and abilities
that are absolutely necessary to perform each function of the position.

MACHINES, TOOLS, EQUIPMENT AND ELECTRONIC DEVICES

Please list the machines, tools, electronic devices, or other equipment
necessary to perform the job.

1.   6.  

2.   7.  

3.   8.  

4.   9.  

5.   10.  

PHYSICAL REQUIREMENTS

From the list of physical requirement descriptions below, check the
box that best describes the physical requirements of the position.

1. [ ] SEDENTARY ACTIVITY:  Lift and carry up to 10 lbs. occasionally;
sedentary work involves sitting most of the time.

2. [ ] LIMITED PHYSICAL ACTIVITY:  Lift and carry up to 10 lbs.
frequently, and up to 20 lbs. occasionally.

3. [ ] LIGHT PHYSICAL ACTIVITY:  Lift and carry 10 to 25 lbs. frequently,
and up to 40 lbs. occasionally.

 

4. [
] MODERATE PHYSICAL ACTIVITY:  lift and carry 25 to 50 lbs. frequently,
and up to 60 lbs. occasionally.

5. [ ] HEAVY PHYSICAL ACTIVITY:  Lift and carry 50 to 80 lbs. frequently,
and up to 100 lbs. or more occasionally.

 
* Occasional is defined as < 50 percent of the time

**
Frequent is defined as > 50 percent of the time

___________________________________________________________________________________________________________________________________

For Personnel Services Use Only

Position
Title: 

Department
Name and Number:    

Position
Classification Code:  Position Number: 

 

ENVIRONMENTAL AND HAZARDOUS CONDITIONS

Check the boxes that best describe the environmental conditions of
the job.

1. [] Work Indoors  (% of time _(

2. [ ] Work Outdoors (% of time ____________)

3. [ ] Respiratory Conditions:  Involving exposure to:

[ ] Noxious Fumes [ ] Dust [ ] Odors [ ] Gases

[ ] Inadequate Ventilation

[ ] Other Conditions (List)   

4. [ ] Skin Conditions:  Involving exposure to:

[ ] Radiation [ ] Toxic Chemicals [ ] Burns

[ ] Electrical Shock [ ] Other Conditions (List)     

5. [ ] Hazardous Conditions:  Including a variety
of physical conditions such as:

[ ] Heavy Machinery [ ] Moving Objects [ ] Vibration

[ ] Proximity to Moving Mechanical Parts

[ ] High Voltage Electricity

[ ] Infectious Diseases

[ ] Working on Scaffolding and High Places

[ ] Extreme Cold (temperatures below 32«»

[ ] Extreme Heat (temperatures above 90«»

[ ] Steam Pipes and/or Tunnels

[ ] Biological and/or Chemical Agents

[ ] Noise (work requires employee to shout to be heard)

[ ] Cramped working quarters

[ ] Use of sharp objects: surgical/laboratory instruments,
knives, needles, food slicing equipment, etc.

[ ] Handling or maintaining animals

[ ] Other hazardous conditions (List)   

 

MENTAL DEMANDS

For each of the mental demands listed below, check the box that best
describes the frequency spent utilizing learned mental skills, and/or
working under conditions that require mental discipline.

NOT DAILY TO WEEKLY TO LESS THAN

MENTAL DEMANDS REQUIRED WEEKLY MONTHLY MONTHLY

CONSTANT INTERRUPTIONS:  Ability to [ ] [  ] [ ] [ ]

work with frequent interruptions.

PLANNING:  Ability to mentally formulate, [ ] [  ] [ ] [ ]

or devise a plan to achieve an end result.

PROBLEM