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pdfPhase 3 Multiple Quote Colle ction Tool
Schedule: ______________
ORS Concepts/Definitions
Bilateral: Two hands/arms or two feet/legs
Essential functions: Job duties that are so fundamental to the position that one cannot do the job without performing the duties.
Frequency: A measure of time NOT the number of occurrences.
Required: Necessary and essential to complete the duties and responsibilities of an occupation and needed for entry into this job.
Unilateral: One hand/arm or one foot/leg
Environmental Condition Factors
1. How much of their day are employees in this job required to work outdoors?
Quote Number
1
2
3
4
5
6
7
8
4
5
6
7
8
Never
Up to 10 mins
10 min to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
2. Excluding weather, how much of their day are employees in this job required to work in extreme cold?
(Extreme cold: 40° for more than 2/3 of the day, 32° if less than 2/3 of the day.)
Quote Number
1
2
3
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
1
Phase 3 Multiple Quote Colle ction Tool
Environmental Condition Factors (continued)
3. Excluding weather, how much of their day are employees in this job required to work in extreme heat?
(Extreme heat: 90°or above in a dry environment, 85° or above in a humid environment.)
Quote Number
1
2
3
4
5
6
7
8
4
5
6
7
8
4
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
4. Excluding weather, how much of their day are employees in this job required to work in humidity?
Quote Number
1
2
3
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
5. How much of their day are employees in this job required to be in contact with water or other liquids?
Quote Number
1
2
3
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
2
Phase 3 Multiple Quote Colle ction Tool
Environmental Conditions Factor (continued)
6. How much of their day are employees in this job required to come in contact with fumes, odors, dust, gases, or poor ventilation that affect the
respiratory system, eyes, or skin?
Quote Number
1
2
3
4
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
7. How much of their day are employees in this job required to work in conditions where bodily injury from toxic, caustic chemicals is possible?
Quote Number
1
2
3
4
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
8. How much of their day are employees in this job required to work in conditions where bodily injury from moving, mechanical parts of equipment, tools,
or machinery is possible?
Quote Number
1
2
3
4
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
3
Phase 3 Multiple Quote Colle ction Tool
Environmental Conditions Factor (continued)
9. How much of their day are employees in this job required to encounter full-body vibration such as a jackhammer operator?
Quote Number
1
2
3
4
5
6
7
8
3
4
5
6
7
8
3
4
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
10. How much of their day are employees in this job required to work in high, exposed places ?
Quote Number
1
2
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
11. How would you describe the noise level where employees in this job typically work?
Quote Number
1
2
Very Quiet - Isolation Booth, Deep Sea Diving
Quiet - Library, Golf Course
Moderate - Office, Retail Store, Light Traffic
Loud - Heavy Traffic, Manufacturing
Very Loud - Jack Hammer, Front Row at a Rock Concert
Don't Know
No Answer
4
Phase 3 Multiple Quote Colle ction Tool
Communication, Auditory, and Vision Requirements
1. How much of their day are employees in this job required to speak?
Quote Number
1
2
3
4
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
2. Does this job require the employee to distinguish moderate sounds such as conversational speech?
Quote Number
1
2
3
4
5
6
7
8
2
3
4
5
6
7
8
2
3
4
5
6
7
8
Yes
No
Don't Know
No Answer
3. Does this job require the employee to distinguish loud sounds such as sirens or alarms?
Quote Number
1
Yes
No
Don't Know
No Answer
4. Does this job require the employee to have a good field of vision (peripheral vision)?
Quote Number
1
Yes
No
Don't Know
No Answer
5
Phase 3 Multiple Quote Colle ction Tool
Communication, Auditory, and Vision Requirements
5. Does this job require the employee to see objects less than 20 inches away clearly?
Quote Number
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
Yes
No
Don't Know
No Answer
6. Does this job require the employee to see objects greater than 20 feet away clearly?
Quote Number
Yes
No
Don't Know
No Answer
Postural Positions – Stoop/Crouch/Kneel
1. Does this job require the employee to stoop, crouch, or kneel?
Quote Number
Yes
No
Don't Know
No Answer
2. Can the employee choose whether they stoop, crouch, or kneel?
Quote Number
Yes
No
Don't Know
No Answer
6
Phase 3 Multiple Quote Colle ction Tool
Postural Positions – Stoop/Crouch/Kneel (continued)
3. How much of their day is spent stooping, crouching, or kneeling?
Quote Number
1
2
3
4
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
4. How much of their day are employees in this job required to stoop (bend the body forward and downward at the waist)?
Quote Number
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
5. How much of their day are employees in this job required to crouch?
Quote Number
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
7
Phase 3 Multiple Quote Colle ction Tool
Postural Positions – Stoop/Crouch/Kneel (continued)
6. How much of their day are employees in this job required to kneel?
Quote Number
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
2
3
4
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
Postural Positions – Crawling/Climbing
1. How much of their day are employees in this job required to crawl?
Quote Number
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
2. How much of their day are employees in this job required to climb ramps or stairs?
Quote Number
1
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
8
Phase 3 Multiple Quote Colle ction Tool
Postural Positions – Crawling/Climbing (continued)
3. How much of their day are employees in this job required to climb ladders, ropes, scaffolds, or poles?
Quote Number
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
Exertion – Sitting/Standing
1. In an 8 hour day, how many hours does this job require the employee to…?
(Enter the appropriate number of hours for each quote.)
Quote Number
Sit
Stand
Don't Know
No Answer
2. Does this job offer the typical employee the choice to alternate between sitting and standing at will throughout the day?
Quote Number
1
2
3
4
5
Yes
No
Don't Know
No Answer
9
Phase 3 Multiple Quote Colle ction Tool
Exertion – Lifting and Carrying
Enter the appropriate number of pounds for each quote.
1. What is the most weight an employee would be required to lift or carry ever?
Quote Number
1
2
3
4
5
6
7
8
4
5
6
7
8
4
5
6
7
8
4
5
6
7
8
Pounds
Don't Know
No Answer
2. What is the most weight an employee would be required to lift or carry for more than 2/3 of the time?
(More than 5 hours and 20 minutes of an 8-hour workday)
Quote Number
1
2
3
Pounds
Don't Know
No Answer
3. What is the most weight an employee would be required to lift or carry from 1/3 up to 2/3 of the time?
(From 2 hours 40 minutes up to 5 hours 20 minutes)
Quote Number
1
2
3
Pounds
Don't Know
No Answer
4. What is the most weight an employee would be required to lift or carry up to 1/3 of the time?
(Up to 2 hours 40 minutes)
Quote Number
1
2
3
Pounds
Don't Know
No Answer
10
Phase 3 Multiple Quote Colle ction Tool
Exertion – Reaching
1. How much of their day are employees in this job required to reach above shoulder level in a forward direction?
Quote Number
1
2
3
4
5
6
7
8
4
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
1A. Does this require one hand/arm or both?
Quote Number
1
2
3
One
Both
Don't Know
No Answer
2. How much of their day are employees in this job required to reach above shoulder level off to the side?
Quote Number
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
2A. Does this require one hand/arm or both?
Quote Number
One
Both
Don't Know
No Answer
11
Phase 3 Multiple Quote Colle ction Tool
Exertion – Reaching (continued)
3. How much of their day are employees in this job required to reach at shoulder level or below in a forward direction?
Quote Number
1
2
3
4
5
6
7
8
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
3A. Does this require one hand/arm or both?
Quote Number
1
2
3
4
One
Both
Don't Know
No Answer
4. How much of their day are employees in this job required to reach at shoulder level or below off to the side?
Quote Number
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
4A. Does this require one hand/arm or both?
Quote Number
One
Both
Don't Know
No Answer
12
Phase 3 Multiple Quote Colle ction Tool
Exertion – Reaching (continued)
5. How much of their day are employees in this job required to reach in any direction?
Quote Number
1
2
3
4
5
6
7
8
2
3
4
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
5A. Does this require one hand/arm or both?
Quote Number
1
One
Both
Don't Know
No Answer
13
Phase 3 Multiple Quote Colle ction Tool
Exertion - Arm/Hand Use(s)
1. How much of their day are employees in this job required to push an object with their hands/arms?
Quote Number
1
2
3
4
5
6
7
8
3
4
5
6
7
8
2. How much of their day are employees in this job required to pull an object with their hands/arms?
Quote Number
1
2
3
4
5
6
7
8
4
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
1A. Does this require one hand/arm or both?
Quote Number
1
2
One
Both
Don't Know
No Answer
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
2A. Does this require one hand/arm or both?
Quote Number
1
2
3
One
Both
Don't Know
No Answer
14
Phase 3 Multiple Quote Colle ction Tool
Exertion - Arm/Hand Use(s) (continued)
3. How much of their day are employees in this job required to hold, grasp, turn, or otherwise work with their hand(s) (gross manipulation)?
Quote Number
1
2
3
4
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
3A. Does this require one hand/arm or both?
Quote Number
1
2
3
4
5
6
7
8
One
Both
Don't Know
No Answer
4. How much of their day are employees in this job required to pick, pinch, or work primarily with the fingers (fine manipulation)?
Quote Number
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
4A. Does this require one hand/arm or both?
Quote Number
One
Both
Don't Know
No Answer
15
Phase 3 Multiple Quote Colle ction Tool
Exertion - Arm/Hand Use(s) (continued)
5. How much of their day are employees in this job required to use a keyboard?
Quote Number
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
__ WPM
__ WPM
__ WPM
__ WPM
__ WPM
__ WPM
__ WPM
__ WPM
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
5A. Is there a word per minute requirement?
Quote Number
Yes: Enter the WPM Requirement
No
Don't Know
No Answer
6. How much of their day are employees in this job required to operate hand/arm controls?
Quote Number
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
6A. Does this require one hand/arm or both?
Quote Number
One
Both
Don't Know
No Answer
16
Phase 3 Multiple Quote Colle ction Tool
Exertion - Leg/Foot Use(s)
1. How much of their day are employees in this job required to push an object with their feet/legs?
Quote Number
1
2
3
4
5
6
7
8
3
4
5
6
7
8
3
4
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
1A. Does this require one foot/leg or both?
Quote Number
1
2
One
Both
Don't Know
No Answer
2. How much of their day are employees in this job required to pull an object with their feet/legs?
Quote Number
1
2
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
2A. Does this require one foot/leg or both?
Quote Number
1
2
3
4
5
6
7
8
One
Both
Don't Know
No Answer
17
Phase 3 Multiple Quote Colle ction Tool
Exertion - Leg/Foot Use(s) (continued)
3. How much of their day do employees in this job pull with the feet only?
Quote Number
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
3A. Does this require one foot or both?
Quote Number
One
Both
Don't Know
No Answer
4. How much of their day are employees in this job required to operate foot/leg controls?
Quote Number
Never
Up to 10 mins
10 mins to 2 hrs 40 mins - (up to 1/3 of the time)
2 hrs 40 mins to 5 hrs 20 mins - (1/3 to 2/3 of the time)
More than 5 hrs 20 mins - (more than 2/3 of the time)
Don't Know
No Answer
4A. Does this require one foot/leg or both?
Quote Number
One
Both
Don't Know
No Answer
18
| File Type | application/pdf |
| Author | keene_t |
| File Modified | 2013-08-15 |
| File Created | 2013-04-16 |