Attachment C Incumbent Diary Form

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Overview

Sheet1
Sheet2

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Sheet 1: Sheet1

A

B

C

D

E

F

G

What were you doing? (Write in the main activity that you were doing) Enter 1 main activity per line

What else were you doing (if anything)? (Write in the other important activity or activities that you were doing)

Start Time

End Time

Mark Which Physical Demand Element Was Present

Standing/Walking

Sitting

Lifting/Carrying

- Amount lifted (lbs)

Pushing/Pulling

Reaching - Overhead

Reaching - At/Below Shoulder

Gross Manipulation

Fine Manipulation

Foot/Leg Controls

Keyboarding

Stooping

Kneeling

Crouching

Crawling

Climbing Ramps/Stairs

Climbing Ladders/Scaffolds

Notes

Started work

End work

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Sheet 2: Sheet2

		Start Time	End Time
6:00 AM		12:00 AM	12:15 AM
6:15 AM		12:15 AM	12:30 AM
6:30 AM		12:30 AM	12:45 AM
6:45 AM		12:45 AM	1:00 AM
7:00 AM		1:00 AM	1:15 AM
7:15 AM		1:15 AM	1:30 AM
7:30 AM		1:30 AM	1:45 AM
7:45 AM		1:45 AM	2:00 AM
8:00 AM		2:00 AM	2:15 AM
8:15 AM		2:15 AM	2:30 AM
8:30 AM		2:30 AM	2:45 AM
8:45 AM		2:45 AM	3:00 AM
9:00 AM		3:00 AM	3:15 AM
9:15 AM		3:15 AM	3:30 AM
9:30 AM		3:30 AM	3:45 AM
9:45 AM		3:45 AM	4:00 AM
10:00 AM		4:00 AM	4:15 AM
10:15 AM		4:15 AM	4:30 AM
10:30 AM		4:30 AM	4:45 AM
10:45 AM		4:45 AM	5:00 AM
11:00 AM		5:00 AM	5:15 AM
11:15 AM		5:15 AM	5:30 AM
11:30 AM		5:30 AM	5:45 AM
11:45 AM		5:45 AM	6:00 AM
12:00 PM		6:00 AM	6:15 AM
12:15 PM		6:15 AM	6:30 AM
12:30 PM		6:30 AM	6:45 AM
12:45 PM		6:45 AM	7:00 AM
1:00 PM		7:00 AM	7:15 AM
1:15 PM		7:15 AM	7:30 AM
1:30 PM		7:30 AM	7:45 AM
1:45 PM		7:45 AM	8:00 AM
2:00 PM		8:00 AM	8:15 AM
2:15 PM		8:15 AM	8:30 AM
2:30 PM		8:30 AM	8:45 AM
2:45 PM		8:45 AM	9:00 AM
3:00 PM		9:00 AM	9:15 AM
3:15 PM		9:15 AM	9:30 AM
3:30 PM		9:30 AM	9:45 AM
3:45 PM		9:45 AM	10:00 AM
4:00 PM		10:00 AM	10:15 AM
4:15 PM		10:15 AM	10:30 AM
4:30 PM		10:30 AM	10:45 AM
4:45 PM		10:45 AM	11:00 AM
5:00 PM		11:00 AM	11:15 AM
5:15 PM		11:15 AM	11:30 AM
5:30 PM		11:30 AM	11:45 AM
5:45 PM		11:45 AM	12:00 PM
6:00 PM		12:00 PM	12:15 PM
6:15 PM		12:15 PM	12:30 PM
6:30 PM		12:30 PM	12:45 PM
6:45 PM		12:45 PM	1:00 PM
7:00 PM		1:00 PM	1:15 PM
7:15 PM		1:15 PM	1:30 PM
7:30 PM		1:30 PM	1:45 PM
7:45 PM		1:45 PM	2:00 PM
8:00 PM		2:00 PM	2:15 PM
8:15 PM		2:15 PM	2:30 PM
8:30 PM		2:30 PM	2:45 PM
8:45 PM		2:45 PM	3:00 PM
9:00 PM		3:00 PM	3:15 PM
9:15 PM		3:15 PM	3:30 PM
9:30 PM		3:30 PM	3:45 PM
9:45 PM		3:45 PM	4:00 PM
10:00 PM		4:00 PM	4:15 PM
10:15 PM		4:15 PM	4:30 PM
10:30 PM		4:30 PM	4:45 PM
10:45 PM		4:45 PM	5:00 PM
11:00 PM		5:00 PM	5:15 PM
11:15 PM		5:15 PM	5:30 PM
11:30 PM		5:30 PM	5:45 PM
11:45 PM		5:45 PM	6:00 PM
12:00 AM		6:00 PM	6:15 PM
		6:15 PM	6:30 PM
		6:30 PM	6:45 PM
		6:45 PM	7:00 PM
		7:00 PM	7:15 PM
		7:15 PM	7:30 PM
		7:30 PM	7:45 PM
		7:45 PM	8:00 PM
		8:00 PM	8:15 PM
		8:15 PM	8:30 PM
		8:30 PM	8:45 PM
		8:45 PM	9:00 PM
		9:00 PM	9:15 PM
		9:15 PM	9:30 PM
		9:30 PM	9:45 PM
		9:45 PM	10:00 PM
		10:00 PM	10:15 PM
		10:15 PM	10:30 PM
		10:30 PM	10:45 PM
		10:45 PM	11:00 PM
		11:00 PM	11:15 PM
		11:15 PM	11:30 PM
		11:30 PM	11:45 PM
		11:45 PM	12:00 AM