SKILLS REQUIRED: NUMBER SKILLS (Check one) WRITING SKILLS (Check one) SENSORY SKILLS (Check all that apply) No number skills required No writing skills required Visual C ounting skills Limited (write and take simple notes) Hearing Basic math skills (+, -, x, /) Extensive (prepare and organize Speaking Advanced math skills (fractions, complete document) Other communication skills acceptable %, formulas, equations) VERBAL COMMUNICATIONS SKILLS (Check one) READING SKILLS (Check one) No verbal communication required KEYBOARD SKILLS (Check one) No reading skills required Limited (give and take directions) No Keyboard skills required Recognition of letters/words Extensive (provide information and Keyboard skills required Understanding of written directions assistance regularly) Other communication skills acceptable OVERALL AMOUNT OF TIME THE EMPLOYEE SPENDS: Standing 65 % Working indoors 100 % Alone 5 % Walking 25 % Working outdoors 0 % In Groups 95 % Sitting 10 % Must total 100% 100 % Must total 100% 100 % Must total 100% 100 % Specify approximate number of people: 10-30 ESSENTIAL RANGE OF MOTION: (Place checkmark in the box that best represents the frequency of each required physical activity) ACTIVITY Never Occasionally Frequently Continuously MOVEMENT Never Occasionally Frequently Continuously Climb Ladder Lift Carry Lift Carry Lift Carry Lift Carry Climb Stairs 0 - 10 lbs. Work underground HAND/FOOT COORDINATION Never Occasionally Frequently Continuously Ride Left Right Left Right Left Right Left Right Shovel Fine Manipulation Sit Gross Manipulation Squat Simple Grasping Stoop/Bend Power Grasping Stretch Hand/Wrist Twisting Twist Foot Use Walk Stand Exposure to dust, gas, or fumes………………………….