Benefits Program Worker II
ADA Checklist
Overall Physical Strength Demands Overall Physical Strength Demands S=Sedentary - Exerting up to 10 lbs. occasionally or small weights frequently; sitting most of the time. Physical DemandsC = Continuously- 2/3 or more of the time. F = Frequently- From 1/3 to 2/3 of the time. O = Occasionally- Up to 1/3 of the time. R = Rarely- Less than 1 hour per week. N = Never- Never occurs.
Standing Frequently- From 1/3 to 2/3 of the time. Sitting Frequently- From 1/3 to 2/3 of the time. Walking Frequently- From 1/3 to 2/3 of the time. Lifting Frequently- From 1/3 to 2/3 of the time. Lifting Amount Exerting up to 10 lbs Carrying Frequently- From 1/3 to 2/3 of the time. Carrying Weight Exerting up to 10 lbs Pushing/Pulling Frequently- From 1/3 to 2/3 of the time. Pushing/Pulling Weight Exerting up to 10 lbs Reaching Occasionally- Up to 1/3 of the time. Handling Occasionally- Up to 1/3 of the time. Fine Dexterity Frequently- From 1/3 to 2/3 of the time. Kneeling Occasionally- Up to 1/3 of the time. Crouching Rarely- Less than 1 hour per week. Crawling Rarely- Less than 1 hour per week. Bending Occasionally- Up to 1/3 of the time. Twisting Frequently- From 1/3 to 2/3 of the time. Climbing Occasionally- Up to 1/3 of the time. Balancing Rarely- Less than 1 hour per week. Vision Continuously- 2/3 or more of the time. Hearing Continuously- 2/3 or more of the time. Talking Continuously- 2/3 or more of the time. Foot Controls Continuously- 2/3 or more of the time. Machines, Tools, Equipment and Work Aids Used Computer, copier, fax, telephone, scanner, adding machine, calculator, printer, care, and related equipment. Protective Equipment Required N/A Health and SafetyD = Daily W = Several Times Per Week M = Several Times Per Month S = Seasonally N = Never
Mechanical Hazards N = Never Chemical Hazards N = Never Electrical Hazards S = Seasonally Fire Hazards S = Seasonally Explosives S = Seasonally Communicable Diseases S = Seasonally Physical Danger or Abuse S = Seasonally Other If Other, Description Environmental FactorsD = Daily W = Several Times Per Week M = Several Times Per Month S = Seasonally N = Never
Dirt and Dust D = Daily Extreme Temperatures D = Daily Noise and Vibration D = Daily Fumes and Odors D = Daily Wetness/Humidity D = Daily Darkness or Poor Lighting D = Daily Primary Work Location Office Environment Non-Physical DemandsC = Continuously- 2/3 or more of the time. F = Frequently- From 1/3 to 2/3 of the time. O = Occasionally- Up to 1/3 of the time. R = Rarely- Less than 1 hour per week. N = Never- Never occurs.
Time Pressures Continuously- 2/3 or more of the time. Emergency Situations Frequently- From 1/3 to 2/3 of the time. Frequent Change of Tasks Continuously- 2/3 or more of the time. Irregular Work Schedule/Overtime Occasionally- Up to 1/3 of the time. Performing Multiple Tasks Simultaneously Continuously- 2/3 or more of the time. Working Closely with Others as Part of a Team Continuously- 2/3 or more of the time. Tedious or Exacting Work Continuously- 2/3 or more of the time. Noisy/Distracting Environment Continuously- 2/3 or more of the time. Other If Other, Description Can anyone assist the employee in performing the primary tasks assigned to this position? If yes, identify the eligible task(s) NoProfessional References
Professional ReferencesPlease provide contact information for professional references.
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