Iwk Health Centre

POSITION QUESTIONNAIRE

JOB IDENTIFICATION:

Organization:

PositionTitle:

Department/Program Area:

Date:

SECTION I:REPORTING RELATIONSHIPS:

1 (A)(i)Your Supervisor’s Title:

(ii)His/Her Supervisor’s Title:

(iii)If you supervise staff, list the position titles that report directly to you and give a brief description of what each one does. Indicate the number of incumbents in each position title.

Title of PositionNumberResponsibilities

1 (B)Indicate positions other than your Supervisor, which you support through your job function

2.Please attach a current departmental organization chart.

SECTION II:EDUCATION & EXPERIENCE:

3.What are the minimum education requirements and experience necessary to competently perform your job?

SECTION III:NATURE AND SCOPE OF POSITION:

4.What is the main purpose (or objective) of your job?

5.Describe five (5) to seven (7) most important elements or responsibilities of your job. Please indicate the approximate percentage of time spend on each.

6.Indicate the nature and extent of contacts and/or professional associations (both within and outside the organization) that are in your job.

7.(a) What aspects of your job are the most difficult? Please provide examples.

(b)What aspects of your position are the most challenging? Please give examples.

SECTION IV:DECISION MAKING:

8.a)What decisions or actions can you take yourself without obtaining prior approval?

b)What decisions or actions do you inform your Supervisor about before you take action?

c)What kind of decisions must you go to your Supervisor for?

d)What types of recommendations does your Supervisor rely upon you to make?

9.List three to seven major end results which your job is intended to accomplish. These should be fairly broad end results, not a list of activities.

10.Please provide data to indicate the overall size of the department you manage/supervise or the programs/activities/services on which you have an impact. Approximate estimates are sufficient.

11.(a)Are you aware of any other positions within the organization with the same title as your position? If so, please indicate the number of such positions.

(b)If the answer to 11(a) is yes, does your position have any significant responsibilities that other positions with the same title in the organization do not have? Please explain.

12.Please provide any comments about your job which have not been provided for above, and which you believe are relevant.

SECTION V:WORKING CONDITIONS

13.Describe any intense, unusual or unpleasant working conditions which accompany your job involving the four factors listed below. Consider the combination of intensity, frequency and duration.

1)physical effort or significant restrictions or ability to move about (examples: lifting, handling materials, working in awkward positions).

2)physical environment (loud noises, fumes, danger or working out-of-doors).

3)Sensory attention (examples: concentration required involving seeing, hearing, touching, etc.).

4)mental stress (disruption in lifestyle caused by work schedules or travel requirements, lack of control over work pace).

SIGNATURES:

Prepared by: ______Date:

Signature

Name (Please Print)

Approved by: ______Date:

Signature

Name (Please Print)

Approved by: ______Date:

Signature

Name (Please Print)