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15. Use of arm muscles over <br />extended periods <br />16. Use of leg muscles over <br />extended periods <br />17. Overhead work (over shoulder <br />height) <br />18. Stationary desk or bench work <br />with neck bent forward <br />X <br />X <br />X <br />X <br />Are the following weights lifted? If yes, describe. <br />What object(s) are lifted: <br />0 - 10 pounds X Manuals, books, files. <br />11 - 24 pounds X <br />25 - 34 pounds X From what height to what height? <br />35 - 50 pounds X 1 to 3 feet. <br />51 - 74 pounds <br />75 - 100 pounds <br />Are the following weights carried? If yes, describe. <br />How far are these weights carried? <br />0 - 10 pounds X 1 foot to 100 feet. <br />11 - 24 pounds X <br />25 - 34 pounds X <br />35 - 50 pounds X <br />51 - 74 pounds <br />75 - 100 pounds <br />Job requires: <br />Working outdoors? X Yes No <br />Working indoors? X Yes No <br />Operating forklifts, dangerous <br />machinery or vehicles? Yes X No <br />Supervising other employees? Yes X No <br />Working with chemicals? Yes X No <br />Working near fumes/vapors? X Yes No <br />Created: August 2013 <br />