ORS PPD-4G Occupational Requirements Survey Govt Collection Form

U.S. Department of Labor

Occupational Requirements
Survey

Bureau of Labor Statistics
Government Industry

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

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 (12200189), 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.

Schedule number:
Total Employment:

Start:

Selected Occupations

Occ. Emp. FT/PT

End:

SOC

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

ORS FORM PPD-4G

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August 2023

Schedule/Quote: ___________

Work Schedule: ____________

Job Title
Job Observation: ☐ Yes ☐ No
Critical Job Function:

Work Schedule Varies: ☐ Yes ☐ No

Job Description (Y/N)

Task List:

FT/PT

Minimum Education

Experience

Credentials

On the Job Training

10% Tasks:

Driving (yes/no)
Vehicle Type?
Supervisory Data:
Lead/Supervisor/Manager/None
Work Checked:
• Every few minutes
• At least 1x/hour
• At least 1x/day
• At least once per week
• Less than once per week, including
never
Supervisor Present? Y/N

ORS FORM PPD-4G

2

August 2023

Work-Related Communication:
Verbal Interactions-Internal
• Every few minutes
• At least 1x/hour
• At least 1x/day
• At least once per week
• Less than once per week, including never

Verbal Interactions-External
• Every few minutes
• At least 1x/hour
• At least 1x/day
• At least once per week
• Less than once per week, including never

Speaking (duration)
People Skills (basic, more than basic)
Public Work Area? Y/N

Crowds? Y/N

Telework? Y/N

Hearing:
In-Person Speech? Y/N Telephone? Y/N Other Remote Speech? 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

Sit/Stand/Walk
Duration
Other
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
ORS FORM PPD-4G

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Notes

August 2023

Reaching/Manipulation
Overhead Reaching
At/Below Shoulder Reaching
Gross Manipulation
Fine Manipulation (FM)
FM includes keyboarding?
Foot/Leg Controls
Postural
Work at or below knee level

One/Both
One/Both
One/Both
One/Both
Y/N/Unk
One/Both

Stooping
Kneeling
Crouching
Crawling
Postural – Climbing
Ramps or Stairs, Structural
Ramps or Stairs, Workrelated
Ladders, Ropes, or Scaffolds
High, Exposed Places
Vision
Near Visual Acuity
Far Visual Acuity
Peripheral Vision
Environmental Conditions
Outdoors
Extreme Heat (non-weather)
Extreme Cold (non-weather)
Wetness
Humidity (non-weather)
Heavy Vibration
Hazardous Contaminants
Proximity to Moving
Mechanical Parts

ORS FORM PPD-4G

Duration

Y/N/Unk
Reqd/Choice
/No/Unk
Reqd/Choice
/No/Unk
Reqd/Choice
/No/Unk
Reqd/Choice
/No/Unk
Other
Y/N

Notes

Y/N PPE
Y/N
Y/N
Y/N

Y/N PPE
Y/N PPE

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August 2023