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Are <br /> <br />Are <br /> <br />Job <br /> <br />the following weights lifted? <br /> <br /> 0 - 10 pounds <br />11 - 24 pounds <br />25 - B4 pounds <br />35 - 50 pounds <br />51 - 74 pounds <br />75 - 100 pounds <br /> <br />the following <br /> <br />X <br /> <br />weights <br /> <br />carried? <br /> <br /> 0- 10 pounds <br />11-24pounds <br />25- 34 pounds <br />35 ~ 50 pounds <br />51-74 pounds <br />75- 100 pounds <br /> <br />X <br /> <br />requires: <br /> <br /> Working outdoors? <br /> Working indoors? <br /> <br /> Operating forklifts, dangerous <br /> machinery or vehicles? <br /> <br /> Supervising other employees? <br /> Working with chemicals? <br /> Working near fumes/vapors? <br /> <br />If yes, describe. <br /> <br /> What object(s) are lifted: <br /> <br />Reams of paper for printer <br /> <br />From what height to what height? <br />0, foot to 3, feet. <br /> <br />If yes, describe. <br /> <br /> How far are these weights <br /> <br />1 foot to 20. feet. <br /> <br />carried? <br /> <br />X <br /> <br />Yes <br /> <br />Yes <br /> <br />Yes <br /> <br />Yes <br /> <br />Yes <br /> <br />X <br /> <br />X <br /> <br />No <br /> <br />X <br /> <br />No <br /> <br />No <br /> <br />No <br /> <br />Recording Secretary <br />Page 4 of 5 <br /> <br /> <br />