Attachment 2 - Advanced MQ Collection Tool

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Schedule: ______________

EXERTION
Quote Number
Standing/Walking and Sitting:
Standing/Walking

1

3

4

5

6

7

8

Time

Sitting

Time

Employee choice (at will)

Y/N

Lifting/Carrying:
… ever?

2

lbs.

… more than 2/3 of the time

lbs.

... 1/3 to 2/3 of the time

lbs.

... seldom to 1/3 of the time

lbs.

... seldom

lbs.

NOTES AND EXAMPLES

Advanced MQ Format – Phys. Demands and Env. Conditions

Page 1

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HAND/ARM, FOOT/LEG, REACHING
1

Quote Number
Pushing/Pulling - Hand/Arm
Exerting force to move an
object towards or away

2

3

4

5

6

7

8

Time
Uni/Bi

Pushing/Pulling - Foot/Leg
Exerting force to move an
object towards or away

Uni/Bi

Pushing/Pulling - Feet only

Time

Time

Uni/Bi
Foot/Leg Controls: Use of one or
both feet to move controls on
machinery or equipment.
Reaching overhead:
Extending hand/arm between 150° to
180° of a vertical arc.
Reaching at/below the shoulder:
Extending hand/arm from 0°
up to 150° of a vertical arc.

Time
Uni/Bi
Time
Uni/Bi
Time
Uni/Bi

NOTES AND EXAMPLES

Advanced MQ Format – Phys. Demands and Env. Conditions

2

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HAND/ARM, POSTURAL POSITIONS
Quote Number
Keyboarding: capture time for each
type of device

1

2

3

4

5

6

7

8

Std.
10-key
Touch
Other

Gross Manipulation: hold, grasp, turn,
or otherwise work with the hands
Fine Manipulation: pick, pinch, or work
primarily with the fingers
Stoop: bending at waist with use of
lower extremities and back muscles
Crouch: bending legs and spine
Kneel: bending legs at knees to come
to rest on knees

Time
Uni/Bi
Time
Uni/Bi
Time
Time
Time

NOTES AND EXAMPLES

Advanced MQ Format – Phys. Demands and Env. Conditions

3

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POSTURAL POSITIONS, VISION REQUIREMENTS
Quote Number
Crawling: Moving about on
hands/knees or hands/feet
Climbing ramps/or stairs
If present, determine if it is a
function of the building (Y/N)
Climbing ladders, ropes, or scaffolding
Near visual acuity
Far visual acuity
Peripheral vision

1

2

3

4

5

6

7

8

Time
Time
Bldg.
Time
Y/N
Y/N
Y/N

NOTES AND EXAMPLES

Advanced MQ Format – Phys. Demands and Env. Conditions

4

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AUDITORY REQUIREMENTS, ENVIRONMENTAL CONDITIONS
Quote Number
Communicating verbally

1

2

3

4

5

6

7

8

Time

Hear and understand conversational
speech

Y/N

Hear and respond to auditory signals
(excluding fire alarms)

Y/N

Noise intensity level
• Q - Quiet (Library, Golf Course)
• M - Moderate - (Office, Retail Store,
Light Traffic)
• L - Loud (Heavy Traffic,
Manufacturing)
• VL - Very Loud (Jack Hammer, Front
Row at a Rock Concert)

Q
M
L
VL

NOTES AND EXAMPLES

Advanced MQ Format – Phys. Demands and Env. Conditions

5

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ENVIRONMENTAL CONDITION FACTORS
Quote Number

1

2

3

4

5

6

7

8

Outdoors
Time
Extreme Heat (exclusive of weather)
above 90° in a dry environment,
above 85° in a humid environment

Time

Extreme Cold (exclusive of weather)
40° or below for 2/3 of day or more,
Time
32° or below if less than 2/3 of day
(40°
for 2/3 of
daywater
or more/32°
if less than 2/3)
Any contact
with
or liquids
(wetness)

Time

Non-weather related humidity
(job related)

Time

NOTES AND EXAMPLES

Advanced MQ Format – Phys. Demands and Env. Conditions

6

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ENVIRONMENTAL CONDITION FACTORS
Quote Number

1

2

3

4

5

6

7

8

Heavy vibration
Time
Fumes, noxious odors, dust, gases, or
poor ventilation affecting the
respiratory system, eyes, or skin

Time

Proximity to moving mechanical parts
with possible bodily injury from
equipment, tools, or machinery

Time

High, exposed places with possible
bodily injury from falling

Time

Toxic, caustic chemicals that burn or
destroy living tissue

Time

NOTES AND EXAMPLES

Advanced MQ Format – Phys. Demands and Env. Conditions

7

ORS

Private Industry sample Establishments:
The Bureau of Labor Statistics, its employees, agents, and partner statistical
agencies, will use the information you provide for statistical purposes only and will
hold the information in confidence to the full extent permitted by law. In accordance
with the Confidential Information Protection and Statistical Efficiency Act of 2002
(Title 5 of Public Law 107-347) and other applicable Federal laws, your responses
will not be disclosed in identifiable form without your informed consent.

This report is authorized by law, 29 U.S.C. 2.
Your voluntary cooperation is needed to
make the results of this survey
comprehensive, accurate and timely.

O.M.B. # 1220-0164
Expires 4/30/15

We estimate that it will take an average of 60 minutes to complete this interview, including time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing this information. If you have any comments regarding this estimate or any other aspect
of this survey; including suggestions for reducing this burden, please send them to the Bureau of Labor Statistics, Office of Compensation and Working
Conditions (1220-0164), 2 Massachusetts Avenue N.E., Washington, D.C. 20212. You are not required to respond to the collection of information unless it
displays a currently valid OMB control number.

State and Local Government sample Establishments:
The BLS publishes statistical tabulations from this survey that
may reveal the information reported by individual State and
local governments. Upon your request, however, the BLS
will hold the information provided on this survey form in
confidence.

This report is authorized by law, 29 U.S.C. 2. Your voluntary
cooperation is needed to make the results of this survey
comprehensive, accurate and timely.

O.M.B. # 1220-0164
Expires 4/30/15

We estimate that it will take an average of 60 minutes to complete this interview, including time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing this information. If you have any comments regarding this estimate or any other aspect
of this survey; including suggestions for reducing this burden, please send them to the Bureau of Labor Statistics, Office of Compensation and Working
Conditions (1220-0164), 2 Massachusetts Avenue N.E., Washington, D.C. 20212. You are not required to respond to the collection of information unless it
displays a currently valid OMB control number.

Advanced MQ Format – Phys. Demands and Env. Conditions

8