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Are the following weights carried? If yes, describe. <br />How far are these weights carried? <br />0 - 10 pounds <br />1 foot to 100 feet. <br />11 - 24 pounds X <br />25 - 34 pounds <br />35 - 50 pounds <br />51 - 74 pounds <br />75 - 100 pounds <br />Job requires: <br />Working outdoors? Yes X No <br />Working indoors? X Yes No <br />Operating forklifts, dangerous <br />machinery or vehicles? Yes X No <br />Supervising other employees? X Yes No <br />Working with chemicals? Yes X No <br />Working near fumes/vapors? Yes X No <br />Page 6 of 6 <br />