Essential Functions Worksheet

Essential Functions Worksheet-FAQ’S and Instructions for Completion of the Form

1.  Q. What is the purpose of the Essential Functions Worksheet (EFW)?

A. The County utilizes the Essential Functions Worksheet in a number of ways:

¨  To develop Job Bulletins for Hiring;

¨  Post-offer pre-hire Physical;

¨  Fitness for Duty examinations;

¨  Disability Retirement;

¨  ADA reasonable accommodation; and

¨  Workers' Compensation and Long Term Disability.

2.  Q. If one assignment in a job class performs an essential function such as billing, and another

assignment does not is billing listed as an essential function?

A. Yes. The EFW reflects the whole job class. Assignments specific to one individual should be listed using a range of hours the task is performed in a week. If billing is done by only one individual for 10 hours a week, the range would be listed as 0-10. Zero would represent everyone that does not do billing, and 10 would represent the task hours for the one person doing the billing.

3.  Q. Do you ever need to fill out more than one EFW for a job class?

A.  Yes, if the requirements of a position vary significantly from those of other positions in the class, e.g., a Public Health Assistant who inspects swimming pools should have a different EFW from a Public Health Assistant who performs HIV test counseling.

4.  Q. What is the Physician Use Only column used for?

A. These columns will be completed by a physician if a specific employee is to be reviewed for a disability.

Instructions for Completion of the EFW Form

The form may be revised as needed. Rows may be deleted or added to complete the EFW.

1. Essential Functions

List all essential functions in the first column. In the second column, list the range of hours the task is performed in a week. The total does not have to equal 40 hours a week. Infrequent functions are still considered essential if serious consequences result from non-performance even if the function is performed intermittently (e.g., tasks required during a flood, an election, or year-end tasks).

List the task/function, not how it is presently performed.

If required, indicate the knowledge base or level of expertise, and the necessity of staying current in the field. (e.g., Child Welfare Code, Nursing Certification)

Job classes with multiple levels such as I/II and/or III as a lead person, may be listed on one worksheet.

2. Typical Job Duties/Tasks and Physical/Environmental Factors

Complete Section 2 using the frequency definitions listed on page one of the EFW, or list the range of hours the task is performed per day.

3. Lifting and Carrying

Check the appropriate box for frequency of occurrence. Make a note in Sec 7 if the items are awkward or unusual.

4. Sensory

Check if required in the job description.

5. Mental Activities

Check all that apply. Use lower section, Usually a Supervisor/Mgr, for the lead person’s additional functions.

6. Other

Check if required in County Job description. (Note: Vaccination for Hepatitis B is available to anyone exposed.)

7. Supervisor/Manager’s Comments

This section is used to clarify/explain any item(s) on the previous pages, that need in-depth discussion.

8. Physician Comments

This section allows the physician to provide details in addition to the Yes or No responses.

9. Signatures

You may submit electronic EFWs by typing your name where your signature is indicated and forwarding to the next reviewer by email. The final version will be housed with Human Resources/EEO, Linda Jenkins.

Essential Functions Worksheet

Job Class / Dept / Division
Job Class #

SECTION 1.

Essential Functions (specific skills that are required for the job class). Note: the usual numbers of hours per week do not have to equal 40.

Essential Functions cannot be reassigned to another employee or modified without causing significant work disruption. / Usual Number of Hours a week / Physician Use Only
Employee can perform / County Modification available
Y/N / Temporary
or
Permanent

T P

/ Physician Use Only
Employee can perform
1. 
2. 
3. 
4. 
5. 
6. 
7. 
8. 
9. 
10. 
11. 
12. 
A Lead worker may also complete the following functions, in addition to those listed above:
13. 
14. 
15. 
16. 
17. 

SECTION 2.

DIRECTIONS BELOW ARE FOR SECTION TWO ON THE FOLLOWING PAGE

Typical Job Duties/Tasks:

The table below contains descriptions for frequency rate typically required for the physical and environmental activities listed on the following page. This section may be completed using either frequency descriptions OR hours in a day may be used to specify how often the activity occurs.

Note: Time ranges listed below are approximate and may overlap with those of other activities so they may total

more than 40 hours in a week.

Frequency / 8-Hour Shift / 10-Hour Shift / 12-Hour Shift
Not Required (NR) / 0 / 0 / 0
Rarely (R) 0-10% / Up to 45 Minutes / Up to 1 Hour / Up to 1.25 Hours
Occasionally (O) 11-33% / 45 Min. to 2.5 Hours / 1 to 3.5 Hours / 1.25 Hrs. to 4 Hrs.
Frequently (F) 34-66% / 2.5 to 5.5 Hours / 3.5 to 7 Hours / 4 to 8 Hours
Continuously (C) 67-100% / 5.5 to 8 Hours / 7 to 10 Hours / 8-12 Hours

SECTION 2.

Typical Job Duties/Tasks

PHYSICAL

/

ENVIRONMENTAL

Revised 03/03 5

Functional Activities / Maximum Requirement / Physician Use Only / Functional Activities / Maximum Requirement / Physician Use Only

Revised 03/03 5

Do not have to
Equal 40 hrs. / Frequency
Per DAY / Or Hr/
DAY / Do not have to
Equal 40 hrs. / Frequency Per DAY / Or Hr/
DAY
Use of keyboard,
Sporadic 10-key / Work Inside
Use of mouse or alternative input device / Work Outside
Finger Manipulation,
Continuous 10-key,
Handwriting / Work closely with others
Wrist Turning (locking/unlocking, door knob, screwdriver) / Working Alone
Grasping or Pinching
(firm) / Driving
Pushing/Pulling / Operation of Hand or Foot Controls
Telephone use
(If without headset check here ) / Unprotected heights: Rooftop, loading dock, ladder, stairs
Neck Motion (Left/right, up/down) / Being around moving machinery: Traffic, elec. lift, tractor, presses
Reaching Forward / Exposure to marked changes in temperature & humidity: Outside temp 28-110 degrees
Sitting
(can stand up at will) / Exposure to dust, fumes, smoke, gases, or other irritating substances: Paint, glue
Standing (Static)
(Working at a counter) / Exposure to slippery or uneven walking surfaces: Construction obstacles, mud, undeveloped ground
Walking / Exposure to solvents or chemicals
Twisting spine / Vibration-chainsaws, jack hammers, jig saws, sanders
Repetitive Bending / Exposure to excessive noise
Stair Climbing / Working with explosive or exposure to electrical energy
Ladder/stepstool
(as a tool) / Working with hands in water or other substance
Kneeling / Working below ground: basement, excavation, trench
Squatting
(Unloaded, 2 knees) / Driving material handling and cleaning equipment, forklift, hand truck
Stooping (1 knee) / In a Fixed POST assignment
(May not leave without having replacement employee cover assignment) 911 Emergency Dispatch, Correctional Officer
Crawling
Section 3. Lifting and Carrying:
Assumes walking on level ground in dry conditions and carrying at waist height. Please note if
awkward or oversized items. / Physician
Use Only
Weight / Never / Rarely / Occasionally / Frequently / Continuously
1-10 lbs.
11-20 lbs.
21-35 lbs.
36-50 lbs.
51-75 lbs.
76-100 lbs. +
Section 4. Sensory: This position requires: / Physician Use
Only

Revised 03/03 5

Functional vision, normal or corrected / Yes No
Functional color vision, normal or corrected / Yes No
Functional night vision, normal or corrected / Yes No Doesn’t work nights
Functional hearing, normal or corrected / Yes No
Functional speech / Yes No
A sense of smell or taste / Yes No Not applicable

Revised 03/03 5

Section 5. Mental Activities: skill level needed for this job
Check all that apply / Mental Duties and Tasks / Physician Use
Only
Comprehension Level:
Follow instructions received orally
Follow instructions received in writing
Frequently required to sustain concentration
Nature of Tasks:
Follow set procedures or set sequences
Organize own work
Ask questions or request assistance when needed
On-call and emergency work
Work Pace:
Dealing with emergency and time sensitive situations on an ongoing basis
Tightly scheduled and hurried pace of work activities
Requires precise attention to detail
Meet frequent project deadlines
Long and irregular hours
Limited opportunity for breaks
Requirement to Perform Complex or Varied Tasks:
Attention divided between issues requiring multi-tasking
Frequent use of judgment in routine matters
Situations requiring judgment and adaptation of procedures from one task to another
Requirement to Relate to People:
Employee frequently works with others (co-workers, professionals, public)
Interaction exceeds giving/receiving of instructions
Able to perform under circumstances of emotional stress
Risk of confrontation with violent or assaultive customers
Diffuse residual emotional effects when crisis over
Mgr / Spvr / Lead
Wkr / Employee / Which job classes covered by this EFW are responsible for the tasks?
More than one column may be checked off.
Requirement to Influence People:
Required to negotiate, motivate, redirect, or convince others
Requirement to Make Generalizations, Evaluations, or Decisions without Supervision:
Ability to make quick accurate decisions
Expected to make decisions without supervision
Required to evaluate or make decisions based on experience or knowledge
Requirement to Accept and Carry Out Responsibility for Direction, Control and Planning:
Mgr / Spvr / Lead
Wkr / Employee / Which job classes covered by this EFW are responsible for the tasks?
More than one column may be checked off.
Lead person – acts as supervisor in Supervisor’s absence, has broad technical knowledge
Supervise other employees
Ability to train others
Goal setting and planning for others is an integral part of the position
Responsible for results
Section 6. Other requirements: This position requires: / Physician Use
Only

Revised 03/03 5

Is a Drivers License required for all employees in this job class? / Yes No
If Yes: / Class A Yes No
Class B Yes No
Class C Yes No
Workplace exposure to blood pathogens Yes No Hepatitis B vaccination required Yes No
Professional Certification or Degree Yes No If yes:
Finger Printing Yes No
Psychological Testing Yes No

Revised 03/03 5

7. SUPERVISOR/MANAGER'S COMMENTS
8. PHYSICIAN COMMENTS
9. SUPERVISOR OR SECTION MANAGER REVIEW
Print name / Signature / Date
10. Departmental ADA COORDINATOR REVIEW
Print name / Signature / Date
Risk Management VOCATIONAL REHABILITATION COUNSELOR REVIEW
Print name / Signature / Date
Human Resources ANALYST REVIEW
Print name / Signature / Date
Original to: Human Resources, HR Manager/EEO
Print name / Signature / Date
Physician Review of this EFW
Print name / Signature / Date
Revision/Review of this EFW
Print name / Signature / Date

Revised 03/03 5