Functional Job Analysis

Claimant Name:

Claim Number:

Job Title: Warehouser I-IV

DOT Code: 922.687-058

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FUNCTIONAL JOB ANALYSIS

WORKER'S NAME:CLAIM NUMBER:

JOB TITLE:Warehouser I-IVDOT NUMBER:922.687-058

DATE UPDATED:8/12/05

JOB DESCRIPTION: Responsible for ensuring the proper materials are shipped to final destination.

ESSENTIAL FUNCTIONS: Receive, issue, and maintain all materials necessary in the operation of the storeroom. Develop a complete working knowledge of all materials and their interrelated use and application. Process and maintain all materials, management forms and records by manual or direct entry methods. Maintain a neat and orderly warehouse facility in compliance with all governmental regulations. Be responsible for the disposition of all materials through proper channels. Perform store functions and other duties as assigned.

NON-ESSENTIAL FUNCTIONS: None.

SCHEDULE:Varies, either five 8-hour days or four 10-hour days per week. A 30-minute, unpaid lunch break is provided, as well as two 15-minute breaks, one provided between start and lunch, and the other between lunch and the end of shift.

EQUIPMENT, MACHINES, VEHICLES OPERATED: Dock loaders, forklift, pick-up truck, computer, telephone, pager, electric pallet jack, wrap machine, radio.

TOOLS, IMPLEMENTS USED: Rolling stairs, manual pallet jack, pens, pencils, utility knife, tape gun, staple gun, wrenches, hammer, screw driver.

KNOWLEDGE, SKILLS, AND ABILITIES: Applicant must possess a valid Driver’s License and must have or obtain within 30 days of selection a DOT physical card and Material Handling Equipment Operator’s Certificate. Applicants possessing previous stores experience will enter training program at grade I level. One must also have a First Aid and CPR Card.

VOCATIONAL PROFILE

(Based on an 8-hour day)

MOBILITY FACTORS

POSTURE/MAXIMUMTOTALPOSITIONFREQUENCY

MOVEMENTSCONSECUTIVEDAILYCHANGEOF

MIN/HRSHOURSOPTIONAL?ACTIVITIES

SITTING / 3 Hours / 6 Hours / Yes / Continuous
STANDING / 3 Hours / 6 Hours / No / Continuous
WALKING / 5 Minutes / 3 Hours / No / Occasional
ON FEET / 3 Hours / 8 Hours / No / Continuous

COMMENTS: Worker sits while completing paperwork and operating the forklift. The rest of the work cycle, the Worker stands on the order picker and stand-up forklift, lowers a pallet via the forklift, and then walks when loading/unloading the pallets or gathering material for customers.

POSTURE REQUIREMENTS

ACTIVITYNEVER INTER. OCCAS. FREQ. CONT. FURTHER DESCRIPTION

0%1-10% 11-33% 34-66% 67+%

BALANCE ABOVE GROUND / X
BEND TO WAIST / X / Unloading pallets, during daily work.
BEND TO KNEE / X / Unloading pallets, during daily work.
BEND TO FLOOR / X / Unloading pallets, during daily work.
TWIST/ROTATE / X / Inspecting, inside receiving.
KNEEL / X / Inspecting, inside receiving.
SQUAT / X / Unloading pallets.
CRAWL / X
CLIMB STAIRS / X / Rolling stairs when obtaining items from higher shelves.
CLIMB LADDER / X
REACH (ARM EXTENDED) / X / Operating forklift, completing computer work/paperwork, unloading pallets.
REACH (ABOVE SHOULDER) / X* / Obtaining items from higher shelves.
HANDLING / X / Materials and supplies.
GRASPING / X / Materials and supplies.
FINGERING / X / Writing, computer work.
FLEX/EXTEND WRIST / X / Operating forklift.
FOOT CONTROLS / X / Operating forklift.
OTHER / X

COMMENTS: *Reaching overhead to obtain one item from the shelves as needed throughout the work shift. This requires both hands to be used. In most instances, large quantities are obtained, during which time the forklift or dock picker is used.

PHYSICAL DEMANDS

LIFT: NEVER INTER. OCCAS. FREQ.CONT.OBJECTS: LOWEST - HIGHEST

0% 1-10% 11-33% 34-66% 67+% POINT - POINT

0-10 POUNDS / X / Materials and supplies; 8 inches to waist.
11-20 POUNDS / X / Materials and supplies; 8 inches to waist.
21-35 POUNDS / X / Materials and supplies; 8 inches to waist.
36-50 POUNDS / X / Materials and supplies; 8 inches to waist.
51-75 POUNDS / X* / Materials and supplies, including guidewires, 8 inches to waist
76-100 POUNDS / X
100+ POUNDS / X

CARRY:NEVER INTER. OCCAS. FREQ. CONT. MAXIMUM DISTANCE

0% 1-10% 11-33% 34-66% 67+%CARRIED

0-10 POUNDS / X / Materials and supplies; 1 to 50 yards.
11-20 POUNDS / X / Materials and suppies, 1 to 50 yards.
21-35 POUNDS / X / Material and supplies, 1 to 50 yards.
36-50 POUNDS / X / Material and supplies, 1 to 50 yards.
51-75 POUNDS / X
76-100 POUNDS / X
100+ POUNDS / X

LIFT/CARRY COMMENTS: Workers are not to be lifting items in excess of 50 pounds, as assistive devices such as forklift, pallet jacks, and dock pickers, as well as co-workers, are always available. Items in excess of 10 pounds are not carried, as they are delivered to the appropriate place and unloaded, which requires only lifting. * Buddy system highly recommended, including use of assistive devices.

PUSH/PULL: NEVER INTER. OCCAS. FREQ. CONT.MAXIMUM DISTANCE

MAX. FORCE 0%1-10% 11-33% 34-66% 67+%PUSHED/PULLED

0-10 POUNDS / X / Doors; 1 to 5 feet.
11-20 POUNDS / X
21-35 POUNDS / X
36-50 POUNDS / X
51-75 POUNDS / X
76-100 POUNDS / X
100+ POUNDS / X

COMMENTS: None.

VISUAL ACUITY-SIGHT/SOUND

CONDITIONNEVER INTER.OCCAS. FREQ. CONT.DESCRIPTION

0% 1-10% 11-33%34-66% 67+%

SEEING SMALL DETAIL / X / Pick list.
COLOR DISCRIMINATION / X
VISUAL DISPLAYS / X / Computer screen.
AUDIBLE SIGNALS / X / Intercom, pager, telephone, radio, forklift horn.
ORAL DIRECTIONS / X / Co-workers, lead, supervisor, manager.
OTHER / X

COMMENTS: None.

WORKING CONDITIONS/ENVIRONMENTAL EXPOSURES

CONDITIONNEVERINTER.OCCAS.FREQ. CONT.COMMENTS

0%1-10%11-33%34-66%67+%

FLOOR SURFACE TYPES / X / Cement floor.
GROUND SURFACE TYPES / X / Pavement/asphalt.
SLIPPERY SURFACE / X / Water tracked in from outside.
WORK OUTSIDE / X / Unloading and loading.
WORK INSIDE / X / Warehouse.
ELEVATIONS / X / Picking material and counting.
MOVING OBJECTS AND PARTS / X / Equipment.
WETNESS- CLIMATIC & ENVIRONMENTAL / X / Inclement weather.
TEMP. EXTREMES- CLIMATIC & ENVIRONMENTAL / X / Inclement weather.
CONFINED SPACES / X
SPECIAL CLOTHING / X
SAFETY EQUIPMENT / X / Work boots, long pants, safety harness, gloves.
VIBRATION FROM EQUIPMENT, TOOLS, AND VEHICLES / X / Forklift.
USE OF SOLVENTS / X / Fill battery.
USE OF DETERGENT / X / Washing hands.
CHEMICAL CONTACT / X / Battery acid.
CHEMICAL INHALANT / X / Paint room.
DUST OR PARTICLES / X / Warehouse environment.
OTHER / X

COMMENTS: None.

REASONABLE ACCOMMODATIONS/ACCESSIBILITY- JOB modifications (per employer):

Provided on a case-by-case basis.

The description of this job is based on the above activities. The physical activities a worker performs at any job may change, and this analysis does not attempt to describe unusual circumstances which may occur at this job. This analysis describes the usual and customary job activities as presented to the analyst by the above-referenced sources.

Employer's Signature:Date:______

Renato Pagalilauan

Analyst's Signature:Date:

Victoria Hoover, MSW, CRC

PHYSICIAN'S STATEMENT

INITIAL ONE:

Worker's Name

____RELEASED TO PERFORM THIS JOB.

*____NOT RELEASED TO PERFORM THIS JOB EVER.

____RELEASED TO PERFORM THIS JOB WITH TEMPORARY

RESTRICTIONS IN PLACE UNTILNOTED BELOW.

**____RELEASED TO PERFORM THIS JOB WITH PERMANENT RESTRICTION NOTED BELOW.

Date Worker is released to begin this job.______

Date

Note: If "CAN" is checked above, the physician's signature indicates the Worker is released to return to work for the job identified on this Job Analysis effective the date of physician's signature unless otherwise noted.

Physician's Signature:Date:

*Comments, If Disapproved, please give reasons:

**if restrictions/limitations are necessary, please describe:

ADDENDA

UPPER EXTREMITIES

NECK: NEVER INTER. OCCAS. FREQ. CONT.COMMENTS

0% 1-10% 11-33% 34-66% 67%+

FLEXION / X / Looking down to ground.
EXTENSION / X / Looking up to higher shelves.
ROTATION LEFT / X / Driving forklift.
ROTATION RIGHT / x / Driving forklift.
OTHER / X

COMMENTS: Operating the forklift and dock pickers, requires Workers to look up to determine how much higher to reach the pallets on upper shelves. Once the pallet is reached, then look down to determine how much further to the ground. Operating the equipment also requires Workers to watch out for co-workers and other equipment, rotating neck to the left and right to do this.

DOMINANT HAND

RIGHT: NEVER INTER. OCCAS. FREQ. CONT.COMMENTS

0% 1-10% 11-33% 34-66% 67%+

FINE MANIPULATION / x / Writing, computer work.
GROSS MANIPULATION / X / Materials and supplies.
SIMPLE GRASP / X / Materials and supplies.
POWER GRASP / X / Materials and supplies.
SIMPLE HAND TWISTING / X / Forklift operation.
POWER HAND TWISTING / X / Loosening bolts.
WRIST EXTENSION / X / Controls on forklift.
WRIST FLEXION / X / Controls on forklift.
SPEED REQUIREMENTS / X
OTHER / X

COMMENTS: Computer work requires hands to be used bilaterally for fingering. Gross manipulation, simple grasp, and power grasp with both hands concurrently for materials and supplies. Simple hand grasp for the forklift steering wheel with left hand, while wrist flex and extend for the controls with right hand.

NON-DOMINANT HAND

LEFT: NEVER INTER. OCCAS. FREQ. CONT.COMMENTS

0% 1-10% 11-33% 34-66% 67%+

FINE MANIPULATION / x / Computer work.
GROSS MANIPULATION / X / Materials and supplies.
SIMPLE GRASP / X / Materials and supplies.
POWER GRASP / X / Materials and supplies.
SIMPLE HAND TWISTING / X
POWER HAND TWISTING / X / Loosening bolts.
WRIST EXTENSION / X / Forklift operation.
WRIST FLEXION / X / Forklift operation.
SPEED REQUIREMENTS / X
OTHER