Job Survey Data Collection Tool
Job Title
Location
Department/Division
Years in Position (how many years have you been in this position?)
Reports to (Supervisor/Manager)
Essential Functions (Major Responsibilities)
What are the main duties of your job?
Essential functions are the fundamental, crucial job duties performed in a position. They do not include marginal functions, which are extra or incidental duties done from time to time. For example, a worker at a pizzeria might have these essential functions:
- Setting up station
- Taking Orders
- Preparing the Pizza
- Serving the pizza
- Cashiering
- Clean up
A function may be essential because: The position exists to perform that function. There are a limited number of employees available who could perform that function.
Fill in the fields for 5-7 Essential Functions. Then, under each Function, indicate the tasks associated with that function.
Essential Fun ction 1 - Main Responsibility
Tasks Associated with Essential Fun ction 1 (for example, steps in the process, important duties, reports you prepare, quantitative and qualitative measurements)
Essential Function 2
Tasks Associated with Essential Fun ction 2
Essential Function 3
Tasks Associated with Essential Fun ction 3
Essential Function 4
Tasks Associated with Essential Fun ction 4
Essential Function 5
Tasks Associated with Essential Fun ction 5
Essential Function 6
Tasks Associated with Essential Fun ction 6
Essential Fun ction 7
Tasks Associated with Essential Fun ction 7
Marginal Functions (tasks and projects that are done infrequently but still an important aspect of the job)
This next section asks about people you work with. Internal working relationships would be specific departments, teams, or individuals. External working relationships would be customers, vendors, suppliers, maintenance workers, government entities, etc.
Working Relationships (Internal)
Working Relationships (External)
This section asks about the level of education, job experience, and industry experience required to perform the job.
Education
Certifications - list certifications required in your current job
Job Experience - how many years of work experience are needed to be successful in your current job?
Industry Experience - how many years experience in the industry are needed to be successful ?
In this section, list the special skills required to perform the job. List anything you feel is important to be successful on the job.
Special Technical Skills (equipment, tools, computer, software, etc.) required to perform your current position.
Interpersonal Skills
This section asks you to check the box that reflects how often you perform that physical task.
Physical Dimensions of the Job
Never (0 hours) | Occasionally (-3 hours) | Frequently (3-6 hours per day) | Constantly (6-8+ hours) | |
---|---|---|---|---|
Sitting | ||||
Walking | ||||
Standing | ||||
Bending | ||||
Squatting | ||||
Kneeling | ||||
Crawling | ||||
Twisting (neck) | ||||
Twisting (waist) | ||||
Is repetitive use of hand required? | ||||
Simple grasping (right hand) | ||||
Simple grasping (left hand) | ||||
Power grasping (right hand) | ||||
Power grasping (left hand) | ||||
Fine manipulation (right hand) | ||||
Fine manipulation (left hand) | ||||
Pushing and pulling (right hand) | ||||
Pushing and pulling (left hand) | ||||
Reaching (above shoulder level) | ||||
Reaching (below shoulder level) |
Daily Lifting Requirements of the job
Never (0 hours) | Occasionally (up to 3) | Frequently (3-6 hours) | Constantly (6-8+ hours) | |
---|---|---|---|---|
0-10 lbs | ||||
11-25 lbs | ||||
26-50 lbs | ||||
51-75 lbs | ||||
100+ lbs |
Daily Carrying Requirements of the job
Never (0 hours) | Occasionally (up to 3) | Frequently (3-6 hours) | Constantly (6-8+ hours) | |
---|---|---|---|---|
0-10 lbs | ||||
11-25 lbs | ||||
26-50 lbs | ||||
51-75 lbs | ||||
100+ lbs |
Heaviest item required to be carried (in pounds)
Distance items required to be carried (in feet)
Job Requirements - Yes or No to answer whether you perform this duty on the job.
Yes | No | |
---|---|---|
Driving cars, trucks, forklifts, and other equipment | ||
Working around equipment and machinery | ||
Walking on uneven ground | ||
Exposure to excessive noise | ||
Exposure to extremes in temperature, humidity, or wetness | ||
Exposure to dust, gas, fumes, or chemicals | ||
Working at heights | ||
Operation of foot controls or repetitive foot movement | ||
Use of special visual or auditory protective equipment | ||
Working with bio-hazards such as: blood borne pathogens, sewage, hospital waste, etc. |
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