ORS 4PPD 4GF Occupational Requirements Survey

Occupational Requirements Survey

OMB_ORS_Form_Gov_4PPD-4GF_2021

ORS - State and Local Government

OMB: 1220-0189

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U.S. Department of Labor

Occupational Requirements Survey

Bureau of Labor Statistics
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.

ESTABLISHMENT INFORMATION
Establishment Name
Schedule Number

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

Quote Number
Job Description: ☐ Yes ☐ No

Job Observed: ☐ 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

1

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

☐ Moderate
Noise Intensity Level:
☐ Quiet
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:
☐ Once per day
☐ More than 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

2

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.

☐ Unknown

☐ Unknown

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

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

Note: Duration % = percentage of the worker’s time
None = Lift/Carry not present for duration

Pushing/Pulling

Hands/Arms:
Feet/Legs:

Up to 2%

2% up to
1/3

1/3 up to
2/3

2/3 or
More

Not Present

☐
☐

☐
☐

☐
☐

☐
☐

☐
☐

Present,
Duration
Unknown
☐
☐

One / Both
☐ ☐
☐ ☐

Reaching/Manipulation

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

Up to 2%

2% up to
1/3

1/3 up to
2/3

2/3 or More

Not Present

Present,
Duration
Unknown

One /
Both

☐

☐

☐

☐

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☒ ☒

☐

☐

☐

☐

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ORS FORM 4: PPD-4GF

3

Postural
Up to 2%

2% up
to 1/3

1/3 up to
2/3

2/3 or
More

Not
Present

☐

☐

☐

☐

☐

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
☐ Yes ☐ No

Ramps or Stairs, Structural:

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

Up to 2%

2% up to
1/3

1/3 up to
2/3

2/3 or
More

Not Present

Present,
Duration
Unknown

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

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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☐
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☐
☐

☐
☐
☐
☐
☐

☐
☐
☐
☐
☐

☐
☐
☐
☐
☐

Present,
Duration
Unknown
☐
☐
☐
☐
☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

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ORS FORM 4: PPD-4GF

Personal
Protective
Equipment

4


File Typeapplication/pdf
File TitleORS Collection Form 4PPD-4GF
SubjectORS Collection Form 4PPD-4GF
AuthorPPD
File Modified2021-05-05
File Created2020-05-15

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