ORS 4PPD 4G Occupational Requirements Survey

Occupational Requirements Survey

OMB_ORS_Form_4PPD-4G_2021

OMB: 1220-0189

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U.S. Department of Labor

Bureau of Labor Statistics


Occupational Requirements Survey



State and local government


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, 31 United States Code §§ 1535/FAR 17.5 of the Economy Act. Your voluntary cooperation is needed to make the results of this survey comprehensive, accurate and timely.



O.M.B. #1220-0189

Expires: X/XX/XXXX


We estimate that it will take an average of 66 minutes to complete this form, 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 (1220-0189), 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.








PRINT ADDITIONAL COPIES OF PAGES 2-4, AS NEEDED.

Shape1

Schedule/Quote: ___________ Work Schedule: ____________

Job Title


Work Schedule


Job Description (Y/N)

FT/PT

Job Observation (circle):

Yes - requested

Yes - offered

No

Critical Job Function:


Task List:

Minimum Education

 

Experience

 

Credentials

 

On the Job Training

 10% Tasks:

Driving (yes/no)


Vehicle Type?


Supervisory Data:


Lead/Supervisor/Manager/None


Work Checked: (more than 1x/day, 1x/day,

At least 1x/week, less than weekly)


Supervisor Present? Y/N



Work-Related Communication:

Verbal Interactions (every few min, more than 1x/hour, more than 1x/day, once per day or less)

  Speaking (duration)

 People Skills (basic, more than basic)


 General Public? Y/N

Crowds? Y/N

Telework? Y/N










Job Title


Work Schedule


 Hearing:

In-Person Speech? Y/N Telephone? Y/N Other Remote Speech? Y/N Other Sounds? Y/N

Noise Intensity Level (quiet, moderate, loud, very loud)

PPE? Y/N

 Cognitive:

 Control of Work Load? (machinery/equip/software, numerical perf. target, people, self-paced, other)

 Work Pace? (consistent-fast, consistent-slow, varies)

 Ability to step away? Y/N

 Problem Solving? (more than 1x/day, 1x/day, at least 1x/week, at least 1x/month, less than 1x/month)




Sit/Stand/Walk

 Duration

Other

Notes

Sitting

 



Standing/Walking

 



Sitting/Standing at Will

 

Y/N


Lift/Carry (breaks at 1/10/25/50/75/100 lbs) 


Most weight ever

 



2/3 of the time or more

 



1/3 up to 2/3 of the time

 



2% up to 1/3 of the time

 



Seldom (up to 2%)

 



Pushing/Pulling 


Hands/Arms

 

One/Both


Feet/Legs

 

One/Both


Reaching/Manipulation 


Overhead Reaching


One/Both


At/Below Shoulder Reaching


One/Both


Gross Manipulation


One/Both


Fine Manipulation


One/Both


Foot/Leg Controls


One/Both


Traditional Keyboarding




Postural


Work at or below knee level


Y/N/Unk


Stooping


Reqd/Choice/No/Unk


Kneeling


Reqd/Choice/No/Unk


Crouching


Reqd/Choice/No/Unk


Crawling


Reqd/Choice/No/Unk


Job Title


Work Schedule


Postural – Climbing

 Duration

Other

Notes

Ramps or Stairs, Structural


Y/N


Ramps or Stairs, Work-related




Ladders, Ropes, or Scaffolds




High, Exposed Places


Y/N PPE


Vision


Near Visual Acuity


Y/N


Far Visual Acuity


Y/N


Peripheral Vision


Y/N


Environmental Conditions


Outdoors




Extreme Heat




Extreme Cold




Wetness




Humidity




Heavy Vibration




Hazardous Contaminants


Y/N PPE


Proximity to Moving Mechanical Parts


Y/N PPE



























































































ORS Form 4 PPD-4G

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorHill, W. Steve - BLS
File Modified0000-00-00
File Created2021-10-27

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