Work Environment/Job Activities:
How often does the job require exposure to or completion of the following?
Working at heights above 4 ft.
Working in confined spaces
Risk of injuries from equipment on the job
Hazardous chemicals and fumes, including waste
Bloodborne/airborne pathogens
Please specify other(s) and amount of exposure (i.e., High, moderate, or light)
How often does the job require completion or use of the following?
Sitting, for example at computer workstation, for extended periods of time
Lifting, pushing, and/or pulling objects up to 50lbs.
Lifting, pushing, and/or pulling objects over 50lbs.
Standing or walking with objects up to 10 lbs.
Standing or walking with objects over 10 lbs.
Other physical activity or equipment usage if moderate or high (please explain):