ORS Form 4 PPD-4GF State and local government

U.S. Department of Labor
Bureau of Labor Statistics

Occupational Requirements Survey

State and local government
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ESTABLISHMENT INFORMATION
Establishment Name
Schedule Number

Quote Number

JOB INFORMATION & REQUIREMENTS
Job Title
# Full-time Employees
# Part-time Employees
Minimum Education

Job Description: ☐ Yes ☐ No
Full-time Work Schedule
Part-time Work Schedule

Experience
Non-Degree Credentials
On-the-Job-Training

CRITICAL JOB FUNCTION & TASKS
Critical Job Function
Critical Tasks

10% Tasks

ORS FORM 4: PPD-4GF

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SUPERVISORY INFORMATION
Supervisory Duties:

☐ None

☐ Lead Worker

☐ Supervisor

Frequency of Work Being Checked:
☐ More than once per day
☐ Less than once per day, but at least once per week
Supervisor Present: ☐ Yes

☐ Manager
☐ Once per day
☐ Less often than weekly

☐ No

COMMUNICATION & HEARING

Work Related Communication

Speaking:
☐ Up to 2% ☐ 2% up to 1/3 ☐ 1/3 up to 2/3 ☐ 2/3 or more

(Duration – % of time)
☐ Not Present ☐ Present, Duration Unknown

☐ Not constantly, but more than once per hour
Verbal Interactions: ☐ Constantly, every few minutes
☐ Not more than once per hour, but more than once per day ☐ Once per day or less often
People Skills: ☐ Basic

☐ More than Basic

Working with the General Public:

Working Around Crowds:

☐ Yes ☐ No

Telework:

☐ Yes ☐ No

In-person Speech:

☐ Yes ☐ No

Telephone:

☐ Yes ☐ No

Other Remote Speech:

☐ Yes ☐ No

Other Sounds:

☐ Yes ☐ No

☐ Yes ☐ No

Hearing

☐ Quiet
☐ Moderate
Noise Intensity Level:
Personal Protective Equipment (PPE): ☐ Yes

☐ Loud
☐ No

☐ Very Loud

COGNITIVE DEMANDS
Control of Workload:
☐ Machinery, equipment or software
☐ People (such as customers, supervisor, etc.)
Work Pace:

☐ Consistent – Fast

☐ Numerical performance targets (company determined)
☐ Self-paced by worker
☐ Other (specify) _________

☐ Consistent – Slow

☐ Varies

Pause Control (ability to step away): ☐ Yes ☐ No
Problem Solving:
☐ More than once per day
☐ Once per day
☐ Not every week, but at least once per month

ORS FORM 4: PPD-4GF

☐ Not every day, but at least once per week
☐ Less often than monthly, including never

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PHYSICAL DEMANDS

Sitting vs. Standing/Walking

Sit/Stand at Will:

Sitting (hours or percent)

☐ Yes ☐ No

Standing/Walking (hours or percent)

Lifting/Carrying
lbs. Items lifted

Most Weight Ever Lifted
Seldom
(Up to 2% of the time)
☐ None
☐ Negligible
☐ 1 to 10 lbs.
☐ 11 to 25 lbs.
☐ 26 to 50 lbs.
☐ 51 to 75 lbs.
☐ 76 to 100 lbs.
☐ >100 lbs.

Occasional
(2% up to 1/3 of the time)
☐ None
☐ Negligible
☐ 1 to 10 lbs.
☐ 11 to 25 lbs.
☐ 26 to 50 lbs.
☐ 51 to 75 lbs.
☐ 76 to 100 lbs.
☐ >100 lbs.

Frequent
(1/3 up to 2/3 of the time)
☐ None
☐ Negligible
☐ 1 to 10 lbs.
☐ 11 to 25 lbs.
☐ 26 to 50 lbs.
☐ >50 lbs.

Constant
(2/3 or more or the time)
☐ None
☐ Negligible
☐ 1 to 10 lbs.
☐ 11 to 25 lbs.
☐ >25 lbs.

Note: Duration % = percentage of the worker’s time

Pushing/Pulling

Hands/Arms:
Feet/Legs:

Present,
Duration
Unknown
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☐

Up to 2%

2% up to
1/3

1/3 up to
2/3

2/3 or More

Not Present

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Up to 2%

2% up to
1/3

1/3 up to
2/3

2/3 or More

Not Present

Present,
Duration
Unknown

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One / Both
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Reaching/Manipulation

Overhead
Reaching:
At/Below
Shoulder
Reaching:
Gross
Manipulation:
Fine
Manipulation:
Foot/Leg
Controls:
Keyboarding:

ORS FORM 4: PPD-4GF

One / Both

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Postural
Up to 2%

2% up
to 1/3

1/3 up to
2/3

2/3 or
More

Not
Present

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Work At/Below Knee Level:
Stooping:
Kneeling:
Crouching:
Crawling:

☐ Yes-Required
☐ Yes-Required
☐ Yes-Required
☐ Yes-Required

☐ Yes-Choice
☐ Yes-Choice
☐ Yes-Choice
☐ Yes-Choice

☐ No
☐ No
☐ No
☐ No

Present,
Duration
Unknown
☐

☐ Unknown
☐ Unknown
☐ Unknown
☐ Unknown

Climbing
Ramps or Stairs, Structural:

Ramps/Stairs,
WorkRelated:
Ladders/
Ropes, or
Scaffolds:
High, Exposed
Places:

☐ Yes ☐ No

Up to 2%

2% up to
1/3

1/3 up to
2/3

2/3 or
More

Not Present

Present,
Duration
Unknown

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☐

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Personal
Protective
Equipment

☐

Vision
Near Visual Acuity: ☐ Yes ☐ No
Peripheral Vision:
☐ Yes ☐ No

Far Visual Acuity:
Driving:

☐ Yes ☐ No
☐ Yes ☐ No Vehicle: _________________

ENVIRONMENTAL CONDITIONS

Outdoors:
Extreme Heat
Extreme Cold:
Wetness:
Humidity:
Heavy
Vibration:
Hazardous
Contaminants:
Proximity to
Moving
Mechanical
Parts:

Up to 2%

2% up to
1/3

1/3 up to
2/3

2/3 or
More

Not Present

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Present,
Duration
Unknown
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ORS FORM 4: PPD-4GF

Personal
Protective
Equipment

4