JOB SITE ANALYSIS

Consumer: Report Date:

Employer: Workers w/o disabilities
Address: Workers w/disabilities
Supervisor: Total Employees
Turnover rate ( ) i!" ( ) #edium ( ) $ow
%irst time employer& ( ) 'es ( ) (o
)n t"e *ob Trainin!& ( ) 'es ( ) (o
W)TC& ( ) 'es ( ) (o
)rientation& ( ) 'es ( ) (o
E+its ,learly marked& ( ) 'es ( ) (o
Emer!en,y -ro,edures& ( ) 'es ( ) (o
%irst Aid #arked& ( ) 'es ( ) (o
%ire E+tin!uis"ers& ( ) 'es ( ) (o
-oli,ies and -ro,edures& ( ) 'es ( ) (o
.s t"ere a /nion& ( ) 'es ( ) (o
/ni0orm provided& ( ) 'es ( ) (o
-ersonnel andbook& ( ) 'es ( ) (o
)perate ma,"inery& ( ) 'es ( ) (o
%re1 o0 ,onta,t wit" workers w/o disabilities: Workpla,e atmosp"ere:
2: never 3: seldom 4: o0ten 5: always (C"e,k all t"at apply)
Doin! t"e 6ob ( ) 2 ( ) 3 ( ) 4 ( ) 5 ( ) %riendly7 ,"eer0ul ( ) Aloo07 indi00erent
Work breaks ( ) 2 ( ) 3 ( ) 4 ( ) 5 ( ) 8usy7 Tense ( ) Slow7 rela+ed
$un," ( ) 2 ( ) 3 ( ) 4 ( ) 5 ( ) Stru,tured ( ) /nstru,tured
)00 site so,ial/re, ( ) 2 ( ) 3 ( ) 4 ( ) 5 ( ) 9uiet ( ) (oisy

TAS:/S.TE A(A$'S.S -; 3
.mportant aspe,ts o0 position:
( C"e,k all t"at apply and ,omment )
( ) Readin!
( )-ubli, Conta,t
( ) Routine
( ) Repetition
( ) Speed
( ) T"orou!"ness
( ) *ud!ment
( ) Teamwork
( ) .ndependen,e
( ) <arian,e
( ) #at" Skills
( ) Writin! Skills
( ) Color dis,rimination
Site Cleanliness=
Sa0ety .ssues / Con,erns
#SDS $o,ation=
Sa0ety E1uipment
C"emi,als /sed
Des,ription o0 worker/
-eer !roup
TAS:/S.TE A(A$'S.S -!4
*ob Title Type o0 *ob ( ) .- ;roup ( )
-la,ement meets <o,ational C"oi,e ( ) 'es ( ) (o -la,ement meets Work Week ;oal ( ) 'es ( ) (o
-la,ement meets parameters& ( ) 'es ( ) (o Consistent w/0un,tional ,apabilities& ( ) 'es ( ) (o
Wa!e: -aid by: ( ) Employer ( ) S#SC 8ene0its: ( ) #edi,al ( ) Dental ( ) Si,k $eave ( ) <a,
-ay Dates: Start Date:
*ob Duties -otential %uture Duties
A,,ommodations ne,essary& : ( ) 'es ( ) (o .0 yes7 w"at ones needed&
)t"ers work t"e same s"i0t as ,onsumer& ( ) 'es ( ) (o ow many work durin! t"e same "ours&
ow many employees in t"e same position& Avail o0 supervisor& ( ) 2>>? ( ) @A? ( ) A>? ( ) $ess
#on Tues Wed T"urs %ri Sat Sun
%rom
8reak 8e!in
8reak End
End
Total
*ob Coa," #ont" -ro6e,ted Total
*ob Coa," ours -ro6e,ted
TAS:/S.TE A(A$'S.S -!5
Detailed *ob Des,ription:
*ob Settin! / Re1uirements: (,"e,k all t"at apply)
( ) $i0tin!/ Carryin! ( ) #a,"inery ( ) %in!erin! ( ) andlin! ( ) <ibration
( ) Standin!/ Walkin! ( ) Temperature ( ) and ,ontrols ( ) Seein! ( ) .ndoor
( ) Crou,"in!/ Crawlin! ( ) 8odies o0 water ( ) (oise ( ) earin! ( ) )utdoor
( ) -us"in!/ -ullin! ( ) Climbin! ( ) %umes ( ) Speakin!
( ) Stoopin!/ :neelin! ( ) 8alan,in! ( ) umidity
( ) %oot Controls ( ) Rea,"in! ( ) )pen Cir,uitry
( ) ei!"ts ( ) %eelin!
Can ,onsumer per0orm unrestri,ted a,tivity: ( ) 'es ( ) (o
Travel #ode: Travel Time :
8us Stop or Cross Streets: Clot"in! (eeds: