Position Description Form

Job Title Department Position Reports to (name and title) Completed By and Exemption Status
Position Summary

Location(s)

Essential Duties and Responsibilities List in order of Importance % of Tim e

Non-Essential / Marginal Responsibilities (if applicable) % of Tim e

Education and Experience Supervisory Responsibilities Job Description form July 2009

 Decision-Making Responsibility Additional Information The above statements are intended to describe the general nature and level of work assignments for this job. The description is not intended to be an exhaustive list of all responsibilities, duties and skills required of the assigned personnel.

Employee Signature:
Please print name next to signature

Date

Supervisor Signature: Date

Job Description form July 2009

Physical Demands Record the following physical demands required of the position: Activity Standing Walking Sitting Stooping/Bending % of Time Comments

Weight/Force - Record the range of pounds involved and the frequency. constantly, daily, weekly, monthly, not present Activity Not Constant Daily Weekly Month Present ly ly Lifting Carrying Pushing Pulling Controls Used Hand/Arm Foot

Strength Level

Sedentary

Light

Medium

Heav y

Very Heavy

Frequency Record the Frequency required of the position for each of the activities. N = Not Applicable C = Constantly D = Daily W = Weekly M = Monthly Activity Frequenc Activity Frequency y Climbing Fine Hand Manipulation Balancing Handing Stooping Feeling Kneeling Talking Crouching Hearing Crawling Tasting/Smelling Reaching Near/Acuity Standing Far Acuity Walking Depth Perception Pushing Color Vision Pulling Field Vision Lifting Comments:

Environmental Conditions- Record the environmental conditions and the frequency that each condition is present in position. N = Not Applicable C = Constantly D = Daily W = Weekly M = Monthly Condition Frequen Comments cy Temperature Change Noise Intensity Level Vibrations Exposure to Electrical Shock Exposure to Radiation Exposure to Toxic/Caustic Chemicals Exposure to Blood-borne Pathogens Communicable Diseases Job Description form July 2009

Work in Confined Area

Job Description form July 2009

Protective Clothing or Personal Devices Record the Protective Clothing or Personal Devices used by this position. Protective Gear Gloves Plastic Apron Face Shield Eye Shield Goggles APPROVALS: I understand the anticipated physical requirements and likely environmental conditions associated with this position, both of which are acceptable to me. I understand that these descriptions do not represent a comprehensive list of possible physical demands and environments I may encounter, but rather summarize the most likely scenarios. Employee Signature: Please print name next to signature When Protective Gear Is Worn

Date

Supervisor Signature: Date Prepared By and Date: Manager Approval and Date:

Job Description form July 2009