JOB SKILLS INVENTORY

Employer: _____________________ Job Title: ____________________

Profile Completed By: ______________________ Date: ____________

Agency Code: ________

J01	Travel Options Available at Job Site

1.	Personal individual transportation required.

2.	Limited ride share available.

3.	Served by public transportation.

4.	Multiple options available.

Rating: ___ Rating Comment: _________________________________

J02	Shifts Available at Job Site

1.	Daytime shift only.

2.	Second shift only.

3.	Third shift only.

4.	Multiple options.

Rating: ___ Rating Comment: __________________________________

J03	Weekly Hours Available at Job Site

1.	1 – 9 hours.

2.	10 – 19 hours.

3.	20 – 29 hours.

4.	30 – 40+ hours or multiple options.

Rating: ___ Rating Comment: __________________________________

J04	Job Schedule (Comment required)

1.	Schedule is stable.

2.	Scheduled rotation in shifts.

3.	Varied starting/quitting times.

4.	On-call, at least one-day notice.

5.	On-call, little or no notice.

Rating: ___ Rating Comment: __________________________________

J05	Flexibility in Schedule (Comment required)

1.	No flexibility.

2.	Some flexibility but requires approval process.

3.	Considerable flexibility but under the direction of supervisor.

4.	High flexibility.

Rating: ___ Rating Comment: __________________________________

J06	Attendance

1.	Attendance is not a requirement of the job.

2.	Absences for bona fide reasons are tolerated when pre-authorized.

3.	Maximum of 2 days absence per month for bona fide reasons with policy guidelines.

4.	Greater than 90% attendance is required.

Rating: ___ Rating Comment: __________________________________

J07	Promptness

1.	Promptness is not required.

2.	Tardiness for bona fide reasons tolerated.

3.	Promptness is a policy/cultural requirement.

4.	Promptness is an essential element of the job.

Rating: ___ Rating Comment: __________________________________

J08	Acceptable Appearance

1.	Personal hygiene and cleanliness are not job requirements.

2.	Minimal hygiene and cleanliness standards are required.

3.	Hygiene and cleanliness standards are cultural/environment requirements.

4.	Hygiene and cleanliness are essential standards of the job.

Rating: ___ Rating Comment: __________________________________

J09	Receptive Communication Requirements

1.	Receptive communication is not a requirement of the job.

2.	Gestures or signals meet requirements for communication.

3.	Simple phrases required.

4.	Sentences required.

Rating: ___ Rating Comment: __________________________________

J10	Expressive Communication Requirements

1.	Expressive communication is not a requirement of the job.

2.	Gestures or signals meet requirements for communication.

3.	Simple phrases required.

4.	Sentences required.

Rating: ___ Rating Comment: __________________________________

J11	Peer Interaction Requirements

1.	Interaction with peers not necessary for job performance (social only).

2.	Limited interaction required as job component.

3.	Frequent interaction with peers required to perform job.

4.	Frequent and detailed peer interactions essential to job performance.

Rating: ___ Rating Comment: __________________________________

J12	Supervisor Interaction Requirements

1.	Supervisor interaction not necessary for job performance (social only).

2.	Limited supervisor interaction required as job component.

3.	Frequent supervisor interaction required to perform job.

4.	Frequent and detailed supervisor interactions essential to job performance.

Rating: ___ Rating Comment: __________________________________

J13	External Customer Interaction Requirements

1.	External customer interaction not necessary for job performance (social only).

2.	Limited external customer interaction required as job component.

3.	Frequent external customer interaction required to perform job.

4.	Frequent and detailed external customer interaction essential to job performance.

Rating: ___ Rating Comment: __________________________________

J14	Team Participation

1.	Work team participation is not a requirement of the job.

2.	Job requires work team participation, but only to carry out assigned tasks.

3.	Job requires work team participation including communication, cooperation and

observation of what needs to be done.

4.	Job requires active participation on work teams including goal setting, work

planning; job requires observing workflow and adjusting own activity to meet

unexpected contingencies.

Rating: ___ Rating Comment: __________________________________

J15	Environmental Response Requirements

1.	Does not require a response to stimuli (such as lights, bells, whistles).

2.	Requires simple response to simple stimulus.

3.	Requires direct response to multiple stimuli.

4.	Requires multiple option responses to multiple stimuli.

Rating: ___ Rating Comment: __________________________________

J16	Hearing Requirements

1.	Hearing not necessary to perform job tasks.

2.	Using auditory discrimination for one or more of the following tasks: telephone

usage, conversation, machine operation. (use comments to specify

correction/assistive devices used and residual limits.)

3.	Hearing is required for multiple tasks (e.g. telephone usage, conversation, machine

operation) requiring use of auditory discrimination. (use comments to specify

correction/assistive devices used)

Rating: ___ Rating Comment: __________________________________

J17	Vision Requirements

1.	Vision is not a job requirement.

2.	Job requires useful vision for (specify: near acuity, distance acuity, depth perception,

color and visual field); correction/assistive devices used need not fully remediate.

3.	Job requires full vision for (specify: near acuity, distance acuity, depth perception,

color and visual field); correction/assistive devices used must fully remediate.

Rating: ___ Rating Comment: __________________________________

J18	Touch/Tactile Requirements

1.	Touch/Tactile discrimination is not a job requirement.

2.	Job requires making gross tactile discriminations (e.g. hard to soft, hot to cold).

3.	Job requires fine tactile discriminations (degrees of smoothness, degrees of

temperature).

Rating: ___ Rating Comment: __________________________________

J19	People

1.	Working with other people is not a job requirement.

2.	Job requires working closely with small numbers of people.

3.	Job requires working closely with large numbers of people.

4.	Job requires working with and managing people.

Rating: ___ Rating Comment: __________________________________

J20	Decision Making

1.	Work-related decisions are not requirements of the job.

2.	Two-option decisions required; help available.

3.	Independent two-option decisions expected.

4.	Independent, multiple-option decisions expected.

5.	Independent, multiple-option decisions and explanations of logic used are required.

Rating: ___ Rating Comment: __________________________________

J21	Quality Requirements

1.	Quality is not a requirement of the job.

2.	Quality is a component of job not managed by worker.

3.	Basic quality is a requirement of the job.

4.	Quality is a significant component in both basic and complex aspects of the job.

Rating: ___ Rating Comment: __________________________________

J22	Adaptability Requirements

1.	Adaptability is not a requirement of the job.

2.	Minimal adaptability is required, with outside support and advanced knowledge.

3.	Adaptability is required, without outside support or advanced knowledge.

4.	Complex job demands require frequent initiation of self-managed adaptability.

Rating: ___ Rating Comment: __________________________________

J23	Serving/Assisting

1.	Responding to requests by others is not a requirement of the job.

2.	Job requires responding to gestures and demonstrations of help needed by people.

3.	Job requires responding to verbal requests for serving/assisting.

4.	Job requires recognizing and responding to non-verbal clues that others need

assistance.

Rating: ___ Rating Comment: __________________________________

J24	Sequencing Requirements

1.	Sequencing is not a requirement of the job.

2.	Job requires sequencing 1 – 2 steps.

3.	Job requires sequencing multiple step tasks using checklists.

4.	Job requires initiating, managing, altering the sequence of multiple step tasks based

on workflow.

Rating: ___ Rating Comment: __________________________________

J25	Reinforcement Available

1.	Job provides constantly communicated feedback and cueing.

2.	Job provides high-density environmental feedback.

3.	Job provides occasional contrived feedback.

4.	Job provides only naturally occurring feedback.

Rating: ___ Rating Comment: __________________________________

J26	Pace Requirements

1.	Pace is not a requirement of the job.

2.	Pace is a job component managed by outside forces.

3.	Self managed pace for basic task sequences is required.

4.	Pace is a significant component in all aspects of the job.

Rating: ___ Rating Comment: __________________________________

J27	Repetitive Work

1.	Performing repetitive tasks is not a requirement of the job.

2.	Job requires performing repetitive tasks with high levels of support and

encouragement.

3.	Job requires consistent performance on repetitive tasks with minimum support and

encouragement.

4.	Job requires establishing and maintaining rhythm on repetitive tasks over full work

period without support or encouragement.

Rating: ___ Rating Comment: __________________________________

J28	Time

1.	Time skills are not a requirement of the job.

2.	Identification of time of day activities (e.g. breaks, lunch) required by the job.

3.	Telling time by hour is a required job component.

4.	Detailed time skills are a required job component.

Rating: ___ Rating Comment: __________________________________

J29	Reading

1.	Reading is not a requirement of the job.

2.	Job requires recognizing characters (single numbers or letters) and pictures.

3.	Job requires reading words and phrases.

4.	Job requires reading sentences and basic documents.

5.	Job requires reading complex documents.

Rating: ___ Rating Comment: __________________________________

J30	Written Communication

1.	Written communication is not a requirement of the job.

2.	Job requires writing/printing characters (single numbers or letters).

3.	Job requires recording words and phrases in written form.

4.	Job requires composing basic documents using proper spelling, grammar and

punctuation.

5.	Job requires composing complex, grammatically correct documents.

Rating: ___ Rating Comment: __________________________________

J31	Arithmetic

1.	Arithmetic is not a requirement of the job.

2.	Job requires counting and addition.

3.	Job requires performing both addition and subtraction.

4.	Job requires performing all four arithmetic functions.

Rating: ___ Rating Comment: __________________________________

J32	Math

1.	Math is not a requirement of the job.

2.	Job requires performing all four arithmetic functions with fractions.

3.	Job requires solving algebra problems.

4.	Job requires solving geometry problems.

5.	Job requires use of higher math concepts (statistics, trigonometry).

Rating: ___ Rating Comment: __________________________________

J33	Money

1.	Use of money is not a requirement of the job.

2.	Job requires recognizing relative value coins and bills but not making change.

3.	Job requires making change.

4.	Job requires conducting money exchanges and makes change.

5.	Job requires conducting multiple money and credit exchanges.

Rating: ___ Rating Comment: __________________________________

J34	Copying Data

1.	Recording data is not a requirement of the job.

2.	Job requires copying numbers and letters but not in forms.

3.	Job requires copying words and sentences into forms not requiring precise

placement and size.

4.	Job requires copying information into forms requiring precise placement and sizing.

Rating: ___ Rating Comment: __________________________________

J35	Comparing Data

1.	Making “different-same” judgments of data is not a requirement of the job.

2.	Job requires comparing data to make “different-same” judgments.

3.	Job requires comparing data and making judgments requiring classification into

more than two groups or sequences.

4.	Job requires comparing data against multi-level standards and assigning to

groups based on degree or differentiation.

Rating: ___ Rating Comment: __________________________________

J36	Comparing Objects

1.	Making “different-same” judgments of objects is not a requirement of the job.

2.	Job requires comparing objects to make “different-same” judgments.

3.	Job requires comparing objects and making judgments requiring classification

into more than two groups or sequences.

4.	Job requires comparing objects against multi-level standards and assigning to

groups based on degree or differentiation.

Rating: ___ Rating Comment: __________________________________

J37	Attention to Task

1.	Attention to task is not a requirement of the job.

2.	Attention to task is enforced by constant supervision.

3.	Attention to task is encouraged and reinforced by supervision.

4.	Job requires constant, self-enforced attention to task.

Rating: ___ Rating Comment: __________________________________

J38	Technology

1.	Use of technology such as computers, calculators, and telephones is not a

requirement of the job.

2.	Job requires performing simple tasks using technology pre-programmed by

someone else.

3.	Job requires using technology requiring basic skills involving setup, saving and

otherwise controlling the function of the equipment.

4.	Job requires setting up and operating technology including complex programming,

sequencing and control.

Rating: ___ Rating Comment: __________________________________

J39	Machine Response and Adjustment

1.	Responding to machine cues or warnings is not a requirement of the job.

2.	Job requires operating and tending “one-cue” machines with no adjusting of settings.

3.	Job requires operating “multiple-cue” machines with multiple switch adjustments.

4.	Job requires operating complex machines with multiple and varying

cues/adjustments.

Rating: ___ Rating Comment: __________________________________

J40	Using Stationary Machines

1.	Controlling or using machines is not a requirement of the job.

2.	Job requires feeding work into and/or removing work from machines

with/without prompts.

3.	Job requires responding to signals from machine by activating single position\

controls.

4.	Job requires responding to signals from machine by adjusting multi-position controls.

Rating: ___ Rating Comment: __________________________________

J41	Driving and Operating Vehicles

2.	Job requires operating vehicles that move on a track where steering is not required.

3.	Job requires operating vehicles where a course must be steered within a confined

space or over a well-established route.

4.	Job requires operating vehicles on various routes requiring worker judgment and

decision-making.

5.	Job requires complex driving/operating operations for which substance abstinence

for periods prior to work is mandated.

Rating: ___ Rating Comment: __________________________________

J42	Sit/Stand/Walk

1.	Maintaining a set work position is not a job requirement; any work position can be

accommodated.

2.	Job requires working in several positions (specify standing, sitting, walking) with

considerable accommodation possible.

3.	Job requires working in a single position (specify standing, sitting, walking) with only

minimal accommodation possible.

4.	Job requires standing, sitting, and walking in a standard and inflexible sequence.

Rating: ___ Rating Comment: __________________________________

J43	Upper Body

1.	Use of upper body (including trunk, arms, hands and fingers) including range of

motion, frequency of use and/or precision of movement are not job requirements;

functional limitations can be accommodated.

2.	Job requires use of upper body (specify: trunk, arms, hands and/or fingers) within

limited range of motion, frequency and precision; some accommodation available.

3.	Job requires full use of upper body (specify: trunk, arms, hands and/or fingers) within

pre-determined performance standard for range of motion, frequency and precision;

some accommodation available.

4.	Job requires full use of upper body (specify: trunk, arms, hands and/or fingers) within

pre-determined performance standard for range of motion, frequency and precision;

little or no accommodation available.

Rating: ___ Rating Comment: __________________________________

J44	Lower Body

1.	Use of lower body (including hips, legs and feet) including range of motion,

frequency of use and/or precision of movement are not job requirements; functional

limitations can be accommodated.

2.	Job requires use of lower body (including hips, legs and feet) within limited range of

motion, frequency and precision; some accommodation available.

3.	Job requires full use of lower body (including hips, legs and feet) within

pre-determined performance standards for range of motion, frequency and precision;

some accommodation available.

4.	Job requires full use of lower body (including hips, legs and feet) within

pre-determined performance standards for range of motion, frequency and precision;

little or no accommodation available.

Rating: ___ Rating Comment: __________________________________

J45	Lifting

1.	No lifting required.

2.	Objects weighing less than 10 lbs.

2.	Objects weighing less than 20 lbs.

3.	Objects weighing up to and more than 20 lbs.

Rating: ___ Rating Comment: __________________________________

J46	Working Conditions with Toxic or Caustic Chemicals/Materials

1.	Tolerance for working conditions with cleaning agents, toxic or caustic

chemicals/materials is not a job requirement.

2.	Job requires tolerance for working conditions with one or more of the following:

cleaning agents, toxic or caustic chemicals/materials. (Specify in comments)

Job requires tolerance for working conditions with multiple cleaning agents, toxic or caustic chemicals/materials. (Specify in comments)

Rating: ___ Rating Comment: __________________________________

J47	Working Conditions with Fumes, Odors and/or Dust

1.	Tolerance for working conditions with fumes, odors and/or dust is not a job

requirement.

2.	Job requires tolerance for working conditions with one or more of the following:

fumes, odors and/or dust. (Specify in comments)

Job requires tolerance for working conditions with multiple fumes, odors and/or dust. (Specify in comments)

Rating: ___ Rating Comment: __________________________________

J48	Layout

1.	Job requires working in a single, closed workspace.

2.	Job requires working in an open workspace.

3.	Job requires working in a variety of open and closed space.

4.	Different worksite daily/weekly.

Rating: ___ Rating Comment: __________________________________

J49	Traffic

1.	There is little or no traffic through the workspace where this job is performed.

2.	Job is performed in workspaces where traffic pattern is light.

3.	Job is performed in workspaces where traffic pattern is heavy.

4.	Job is performed in workspaces where traffic pattern varies from light to heavy.

Rating: ___ Rating Comment: __________________________________

J50	Temperature

1.	Adapting to temperature changes of more than a few degrees +/- 70 is not a

job requirement.

2.	Job requires adjusting to extremes of cold. (Specify degree range in comments)

3.	Job requires adjusting to extremes of heat. (Specify degree range in comments)

5.	Job requires adjusting to extreme swings of both cold and heat. (Specify degree

range in comments)

Rating: ___ Rating Comment: __________________________________

J51	Elements/Weather

1.	This job does not involve exposure to weather.

2.	Job requires exposure to weather for short periods.

3.	Job requires infrequent exposure to weather for extended periods.

4.	Job requires frequent and extended exposure to severe weather.

Rating: ___ Rating Comment: __________________________________

J52	Medication

1.	Freedom from use of prescribed medications is not a job requirement.

2.	Job requirements allow prescribed medications that have no impact on

work performance or rules.

3.	Job requires that prescribed medications have no significant side effects.

4.	Job requires freedom from use of medications specified in comments below.

Rating: ___ Rating Comment: __________________________________

J53	Medical Considerations

1.	Job requirements do not impact medical considerations or restrictions.

2.	Medical considerations or restrictions apply to this job.

Rating: ___ Rating Comment: __________________________________

J54	Training Considerations

1.	No training provided.

2.	Co-worker/Supervisor provides all training.

3.	A training specialist/company trainer provides training.

4.	Structured course work/certification provided.

Rating: ___ Rating Comment: __________________________________

J55	Self Directed Work

1.	Basic tasks are assigned in single units and sequence.

2.	Work tasks are assigned and require independent completion of task sequences.

3.	Independent self-directed work, load and sequence.

Rating: ___ Rating Comment: __________________________________

J56	Salary Range

Unknown.

Provide range in comment.

Rating: ___ Rating Comment: __________________________________