Notice of Potential Eligibility for Vocational Rehabilitation by cx89mEO


									The information provided herein is a generic description of the physical demands and environmental
conditions of a specific job title. Prior to relying on this information, you must verify the actual physical
demands and environmental conditions of a job posted by an employer. This information may be used as a
basis for review with a medical provider for return to work efforts and/or as suggested language for an
employer who has not provided a fully descriptive job posting.

                      JOB TITLE: Service Truck Worker, Construction

Drives a service truck to various construction job sites as per dispatcher. Inspects, repairs, and maintains functional
parts of automotive and mechanical equipment and machinery, such as pumps, compressors, pipe-laying machines,
ditchdiggers, trucks, and tractors used in petroleum exploration, on oil fields, in construction, and in airfield maintenance
and pipeline operations, using hoists, hand tools, gauges, drills, grinding wheels, and testing devices:
Inspect brake systems, steering mechanisms, wheel bearings, and other important parts to ensure that they are in
proper operating condition. Perform routine maintenance such as changing oil, checking batteries, and lubricating
equipment and machinery. Adjust and reline brakes, align wheels, tighten bolts and screws, and reassemble
equipment. Raises heavy parts or equipment using hydraulic jacks or hoists. Test drive trucks to diagnose
malfunctions or to ensure that they are working properly. Inspect, test, and listen to defective equipment to diagnose
malfunctions, using test instruments such as handheld computers, motor analyzers, chassis charts, and pressure
gauges. Examine and adjust protective guards, loose bolts, and specified safety devices. Inspect and verify
dimensions and clearances of parts to ensure conformance to factory specifications. Specialize in repairing and
maintaining parts of the engine, such as fuel injection systems. Attach test instruments to equipment, and read dials
and gauges to diagnose malfunctions. Rewire ignition systems, lights, and instrument panels. Recondition and
replace parts, pistons, bearings, gears, and valves. Inspect, repair, and maintain automotive and mechanical
equipment and machinery such as pumps and compressors. Disassemble and overhaul internal combustion engines,
pumps, generators, transmissions, clutches, and differential units. Rebuild gas or diesel engines.

                                                     Physical Demand Level

                                         Sedentary                  Light             Medium           Heavy          Very Heavy
     Occasional Lift: 1-33%              10 lbs.                 20 lbs.             50 lbs.         75 lbs.           >100
     Frequent Lift: 34-66%              Negligible               10 lbs.             20 lbs.         38 lbs.            >50
     Constant Lift: 67-100%             Negligible              Negligible           10 lbs.         15 lbs.            >20

                                                       Work Environment
                              % time                                              % time                                % time
   Extreme Hot                0 - 10               Dustiness                      10 - 15      Below Ground                 N/A
   Extreme Cold               0 - 10               Dampness                        N/A         Uneven Ground                N/A
   Heated area                outside              Vibrations                       10         Fumes/Gases                  10
   Air Conditioned            outside              Unprotected Height             0 - 10       Chemicals                    N/A
   Ventilated                  N/A                 Protective Equipment            100         Works with Others        10 - 20
   Moving Vehicle             20 - 30              Excessive Noise                40 - 50      Works Alone              80 - 90

Page 1 of 4                                                        Job Analysis                                    v10.05
                                                  Equipment and Tools
                    Description                                                 Frequency                  Physical Demands
Equipment           Hoists, grinding wheels, drills, lathes, jacks,            Occasionally           Simple and power grasping,
                    welding equipment                                                                 bilaterally
Tools               Screwdrivers, pliers, wrenches, power tools,                Frequently            Simple grasping with dominant
                    pressure gauges                                                                   hand

                                                    Physical Demands
      Activity          Hours/Day    Continuous     Intermittent            Activity          Hours/Day      Continuous    Intermittent
Stand                   5-6                                        Handle ↑ Shoulder          < 1hr
Walk                    2-3                                        Handle ↓ Shoulder          4-5
Sit                     1-2                                        Bend at Waist              3-4
Crouch                  1-2                                        Twist at Waist             1-3
Stoop                   1-3                                        Repetitive Hands           3-4
Reach                   4-5                                        Fingering                  4-5
Balance                 0-1                                        Repetitive Feet            N/A
Squat                   1-2                                        Climb Stairs               N/A
Kneel                   1-2                                        Climb Ladders              0-1
Crawl                   N/A                                        Tilt Head                  4-6
Push                    1-2                                        Talk                       1
Pull                    1-2                                        Drive                      1-2
Movement with weights:          Occasionally, several feet                                    Amount of Weight      Up to 50 lbs.

                                                       Sensory Demands
      Activity          Hours/Day    Continuous     Intermittent            Activity          Hours/Day      Continuous    Intermittent
Feel                    4-5                                        Depth Perception           N/A
Hear                    1-2                                        Color Vision               N/A
Taste/Smell             N/A                                        Field of Vision            N/A
Near Acuity             8                                          Visual                     N/A
Far Acuity              N/A

                                        Work Hours and Scheduled Breaks
Days        Monday – Friday                    Hours      8/day; 40 hour work week            Breaks     Two, 15-minute; 30 min

Work Environment:
Road builders often carry out several different tasks in a single day, at any number of locations. They may have to
stand for long periods, lift heavy objects, and work in uncomfortably hot or cold environments, in awkward and cramped
positions, or on ladders. They limited work with limited supervision.

Job modification considerations:

If the injured worker has a back strain, for example, and has a temporary work preclusion from repetitive or prolonged
bending and stooping, and/or no heavy lifting, consideration can be given to performing repair work which can be done
from a work bench; or working on machines where the arms are extended at or above waist level, negating the need for
flexion at the waist.
          Page 2 of 4                                       Worksite Job Analysis                                     v10.05
Respectfully submitted,

Vocational Case Manager

      Page 3 of 4         Worksite Job Analysis   v10.05
                                Signature Page for Worksite Job Analysis

Employee Name                                                                Claim Number
Company Name                                                                 Department
Contact Person/Title                                                         # of Employees
Job Title                                                                    DOT #
Person completing JD                                                         Date of JA

I have prepared and reviewed this job description and agree this is an accurate representation of the
position. I agree to the accommodations described within the job description.
Employer signature                                               Date


    I agree this job falls within the functional abilities of this patient.
    I agree this job is within the functional abilities of this patient with the following modifications:

Physician signature                                                                           Date

The job description referenced above has been reviewed with me on             and I have been given a copy
of it. I understand the requirements of the job tasks involved. I agree to contact any or all of the following
parties if I have problems performing the required job tasks:
Supervisor:                                                                          Phone:

Human Resources:                                                                     Phone:
Case manager:                                                                        Phone:

Injured Worker signature                                                                       Date

                                                                                                                     Formatted: Font: Arial, 10 pt
                                                                                                                     Formatted: Normal, Tab stops: Not at 1.13"

       Page 4 of 4                                   Worksite Job Analysis                                  v10.05

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