ORS Form 4 PPD-4P ORS Survey Form

O.M.B. #1220-XXXX

Expires X/XX/XX

Private Industry

Schedule Number		Start			End
Total Employment		PSO Employment

Selected Occupations		Occ. Emp.	FT/PT	U/N	T/I	Observed?
1
2
3
4
5
6
7
8

Private Industry

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ORS Form 4 PPD-4P (XXXX-2014)

Quote #______

JOB DETAILS
Job Title							FT PT		U N		T I
Job Code				SOC
Work Schedule						Job Description				Y N
Non-Supervisory Lead Supervisory

SPECIFIC VOCATIONAL PREPARATION

JOB TASKS/NOTES	EDUCATIONAL REQUIREMENTS
	Minimum education required? If no minimum, must workers be able to read and write?
	Prior work experience required? How much?
	Post-employment training (OJT, mentoring, etc.) required? Type and how much?
	Professional certification, state or industry license, other pre-employment training required? Type and time to obtain?
COGNITIVE ELEMENTS

1. How complicated are the tasks of the occupation?

• Very simple (Clear cut tasks, requiring little or no decision-making)

• Simple (Deciding between a limited number of easily recognizable or established choices)

• Moderate (Deciding between many different alternatives)

• Complex (Judgment required to make decisions regarding many different and unrelated work methods and processes)

• Very complex (Substantial depth of analysis required to make decisions in many areas of uncertainty in approach, methodology, interpretation, or evaluation)

2. How closely controlled is the occupation’s work?

• Very closely (Detailed directions, strict guidelines)

• Closely (Limited instruction on recurring assignments; supervisor assistance with unusual situations)

• Moderately (General guidelines provided; makes minor adjustments; refers unforeseen situations to supervisor)

• Loosely (General objectives; supervision minimal, makes adjustments)

• Very loosely (Goals, priorities and deadlines determine tasks)

Use the following options for 3a, b, and c:

Hourly (At least once every hour of a typical work day)

Daily (Less than hourly but at least once per day)

Weekly (Less than daily but occurs at least once per week)

Monthly (Less than weekly but occurs at least once per month)

Less Often than Monthly (includes never)

3. How often are there deviations from the norm in:

1. Work tasks?

2. Work schedule?

3. Work location?

Regular Contacts: People with whom there is an established working relationship

Other: People with whom there is no established working relationship, includes general public

4. How often does the occupation verbally interact (work related) with regular contacts?

• Hourly (At least once every hour of a typical work day)

• Daily (Less than hourly but at least once per day)

• Weekly (Less than daily but occurs at least once per week)

• Monthly (Less than weekly but occurs at least once per month)

• Less Often than Monthly (includes never)

5. What type of work-related interactions does the occupation have with regular contacts?

• Very structured (Exchanging straightforward, factual information)

• Structured (Coordinating, routine problem-solving)

• Semi-structured (Problem-solving, discussing, some gentle persuading, soft-selling)

• Unstructured (Influencing, persuading, hard-selling, controlling situations)

• Very unstructured (Defending, negotiating, resolving controversial or long-term issues)

5. How often does the occupation verbally interact (work related) with people other than regular contacts?

• Hourly (At least once every hour of a typical work day)

• Daily (Less than hourly but at least once per day)

• Weekly (Less than daily but occurs at least once per week)

• Monthly (Less than weekly but occurs at least once per month)

• Less Often than Monthly (includes never)

5. What type of work-related interactions does this occupation have with people other than regular contacts?

• Very structured (Exchanging straightforward, factual information)

• Structured (Coordinating, routine problem-solving)

• Semi-structured (Problem-solving, discussing, some gentle persuading, soft-selling)

• Unstructured (Influencing, persuading, hard-selling, controlling situations)

• Very unstructured (Defending, negotiating, resolving controversial or long-term issues)

PHYSICAL DEMANDS

Capture duration unless otherwise indicated

Sitting/Standing or Walking	Notes:
Sitting
Standing/Walking
Sitting vs. Standing/Walking at will (Yes/No)
Lifting/Carrying (Collect number of pounds)
Most weight ever
More than 2/3 of the time
1/3 to 2/3 of the time
2%to 1/3
Seldom (<2%)
Pushing/Pulling (Collect duration and one/both)
Hand/Arm (One/Both)
Foot/Leg (One/Both)
Foot Only (One/Both)

Reaching (Collect duration and one/both)	Notes:
Overhead (One/Both)
At/Below Shoulder (One/Both)
Keyboarding
Traditional 10-Key Touch Screen Other (document)
Manipulation (Collect duration and one/both)
Gross (One/Both)
Fine (One/Both)
Foot/Leg Controls (One/Both)
Getting Low
Stooping
Crouching
Kneeling
Crawling
Climbing
Ramps/Stairs, related to job duties or structure, collect duration for job duty related
Ladders/Ropes/Scaffolds

Driving

• Yes/No

• Vehicle Type

Communicative Requirements

Communicating Verbally (Capture Duration)

Hearing:

• Hear and understand one-on-one in person Hear and understand one-on-one in person (Yes/No)

• Hear and understand in a group or conference in person (Yes/No)

• Hear and understand on the telephone (Yes/No)

• Hear and understand other sounds (Yes/No)

• Passage of hearing test required (Yes/No)

Vision:

• Near Visual Acuity (Yes/No)

• Far Visual Acuity (Yes/No)

• Peripheral Vision (Yes/No)

ENVIRONMENTAL CONDITIONS

Capture duration unless otherwise indicated

Noise Intensity Level Select from: Quiet, Moderately Loud, Loud, Very Loud	Notes:
Outdoors
Extreme Heat (non-weather related)
Extreme Cold (non-weather related)
Wetness (non-weather related)
Humidity (non-weather related)
Heavy Vibration
Fumes, Noxious Odors, Dusts, Gases
Toxic, Caustic Chemicals
Proximity to Moving Mechanical Parts
High, Exposed Places