ORS PPD 4GF Occupational Requirements Survey Govt Establishment Form

Occupational Requirements Survey

U.S. Department of Labor
Bureau of Labor Statistics
Government Industry
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O.M.B. #1220-0189

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ESTABLISHMENT INFORMATION
Establishment Name
Schedule Number

Quote Number
Job Description: ☐ Yes ☐ No

JOB INFORMATION

Job Observation: ☐ Yes ☐ No
Full-time ☐ Part-time ☐

Job Title

# Full-time Employees________# Part-time Employees____________
Job Work Schedule ________hrs/day __________hrs/wk ________wks/yr.
Work Schedule Varies?
☐ Yes ☐ No
Critical Job Function
Critical Tasks

10% Tasks

SUPERVISORY INFORMATION
Supervisory Duties:

☐ None

☐ Lead Worker

Frequency of Work Being Checked:
☐ Every few minutes ☐ At least once per hour
☐ Less than once per week, including never
Supervisor Present: ☐ Yes
ORS FORM PPD-4GF

☐ Supervisor

☐ At least once per day

☐ Manager

☐ At least once per week

☐ No
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August 2023

SPECIFIC VOCATIONAL PREPARATION (SVP)
Minimum Education
(If no minimum, must workers
be able to read and write?)

Experience
Credentials
On-the-Job-Training

WORK PACE
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

COMMUNICATION & HEARING

Work Related Communication
Speaking:
(Duration – % of time)
☐ Up to 2% ☐2% up to 1/3 ☐ 1/3 up to 2/3 ☐ 2/3 or more
Internal Verbal Interactions:
☐ Every few minutes ☐ At least once per hour
☐ Less than once per week, including never
External Verbal Interactions:
☐ Every few minutes ☐ At least once per hour
☐ Less than once per week, including never
People Skills: ☐ Basic

☐ Not Present ☐ Present, Duration Unknown

☐ At least once per day

☐ At least once per week

☐ At least once per day

☐ At least once per week

☐ More than Basic

Hearing
In-person Speech:
☐ Yes ☐ No
Telephone:
☐ Yes ☐ No
Other Remote Speech (such as walkie-talkies, intercoms, public address systems, etc.):
☐ Yes ☐ No

Vision
Near Visual Acuity: ☐ Yes ☐ No
Peripheral Vision: ☐ Yes ☐ No
ORS FORM PPD-4GF

Far Visual Acuity: ☐ Yes ☐ No
Driving:
☐ Yes ☐ No Vehicle: _________________
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August 2023

PHYSICAL DEMANDS

Sitting vs. Standing/Walking
Sitting (hours or percent)

Standing/Walking (hours or percent)

☐ Yes ☐ No

Sit/Stand at Will:

Lifting/Carrying
lbs.

Most Weight Ever Lifted
Items lifted/carried
Seldom

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

☐ Unknown

Pushing/Pulling
Up to 2%

2% up to
1/3

1/3 up to
2/3

2/3 or
More

Not Present

☐
☐

☐
☐

☐
☐

☐
☐

☐
☐

Hands/Arms:
Feet/Legs:

Present,
Duration
Unknown
☐
☐

One / Both
☐ ☐
☐ ☐

Reaching/Manipulation
Up to
2%

2% up to
1/3

1/3 up to
2/3

2/3 or
More

Not Present

☐

☐

☐

☐

☐

Present,
Duration
Unknown
☐

☐

☐

☐

☐

☐

☐

☐ ☐

☐

☐

☐

☐

☐

☐

☐ ☐

(include time spent
keyboarding)

☐

☐

☐

☐

☐

☐

☐ ☐

Foot/Leg Controls:

☐

☐

☐

☐

☐

☐

☐ ☐

Overhead Reaching:
At/Below Shoulder
Reaching:
Gross Manipulation:
Fine Manipulation

Keyboarding:

ORS FORM PPD-4GF

One /
Both
☐ ☐

☐ Yes ☐ No ☐ Unknown

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August 2023

Low Postures

☐
☐
☐ Yes-Worker's Choice

☐
☐ No

Present,
Duration
Unknown
☐
☐ Unknown

2% up
to 1/3

Up to 2%
Work At/Below Knee Level:
☐
Stooping:
☐ Yes-Required

☐

1/3 up to
2/3

2/3 or
More

Not
Present

Kneeling:

☐ Yes-Required

☐ Yes-Worker's Choice

☐ No

☐ Unknown

Crouching:

☐ Yes-Required

☐ Yes-Worker’s Choice

☐ No

☐ Unknown

Crawling:

☐ Yes-Required

☐ Yes-Worker’s Choice

☐ No

☐ Unknown

Climbing
☐ Yes ☐ No

Ramps or Stairs, Structural:
Up to 2%

2% up to
1/3

1/3 up to
2/3

2/3 or
More

Not Present

Present,
Duration
Unknown

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

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

Personal
Protective
Equipment

☐

ENVIRONMENTAL CONDITIONS AND WORK SETTING
Present,
Duration
Unknown
☐
☐
☐
☐
☐

Personal
Protective
Equipment

Up to 2%

2% up to
1/3

1/3 up to
2/3

2/3 or
More

Not Present

☐
☐
☐
☐
☐

☐
☐
☐
☐
☐

☐
☐
☐
☐
☐

☐
☐
☐
☐
☐

☐
☐
☐
☐
☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

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

Noise Intensity Level:

☐ Yes ☐ No
☐ Quiet

☐

Working Around Crowds: ☐ Yes ☐ No Telework:
☐ Moderate

☐ Loud

☐ Yes ☐ No

☐ Very Loud

Personal Protective Equipment: ☐ Yes ☐ No
ORS FORM PPD-4GF

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August 2023