Job Analysis Form
Recorder ____________________________
Date of Analysis __________________
Company ____________________________
Job Title _________________________
Supervisors Name/Title _________________________ Telephone ________________
Salary _______________ Work Schedule ___________ Hours/Week ______________
Employee Benefits ________________________________________________________
1.
PERSONAL REQUIREMENTS
Personal Appearance
0 ( ) Grooming unimportant
1 ( ) Only hygiene required
Comments:
2 ( ) Neatness/ Cleanliness required
3 ( ) Grooming very important
Behavior
Comments:
0 ( ) Wide Variety accepted
2 ( ) Unusual behavior not acceptable
1 ( ) Unusual behavior accepted if infrequent
Communication
0 ( ) Non/minimal
1 ( ) Key words needed
Comments:
2 ( ) Sentence/impaired speech accepted
3 ( ) Sentences/clear speech required
Attention
0 ( ) Frequent prompts available
1 ( ) Intermittent props/ high
supervision
Comments:
2 ( ) Intermittent prompts/low supervision
3 ( ) Infrequent prompts/low supervision
Change in Task/Routine
0 ( ) No changes
1 ( ) 2-3 changes/day
2 ( ) 4-6 changes/day
3 ( ) More than 7 changes/day
Comments:
Interactions
0 ( ) Minimal
1 ( ) Polite responses only
2 ( ) Social interactions infrequent
3 ( ) Frequent social
Comments:
2.
TIME/TRAVEL FACTORS
Work Schedule
0 ( ) Negotiable days/hours
1 ( ) Part-time nights/weekends
4 ( ) Full-time/nights/weekends
2 ( ) Part-time M-F/days
3 ( ) Full-time M-F/days
Comments:
Transportation
0 ( ) On bus route
1 ( ) Off bus route
Comments:
2 ( ) Car pool/van pool available
3 ( ) Other _____________________
Time Telling
0 ( ) Time skills unimportant
1 ( ) Must identify break times only
2 ( ) Time telling to hour required
3 ( ) Time telling to minute required
Comments:
Mobility
0 ( ) Sitting/Standing in one area
1 ( ) Moderate mobility required
2 ( ) Stairs/minor obstacles
3 ( ) Rigorous ambulation required
Comments:
3.
WORK TOLERANCE
Endurance
0 ( ) Short day/many breaks
1 ( ) Short day/few breaks
2 ( ) Full day/many breaks
3 ( ) Full day/few breaks
Comments:
Strength
0 ( ) Not important
1 ( ) Little strength needed
2 ( ) Moderate strength needed
3 ( ) Great strength needed
Comments:
4.
PERFORMANCE SKILLS
Initiation of Work
0 ( ) Staff will prompt to next task
1 ( ) Some prompts to initiate work
2 ( ) Some prompts to next task
3 ( ) Independent initiation required
Task Sequencing
0 ( ) Single task
1 ( ) 2-3 tasks in sequence
Comments:
2 ( ) 4-6 tasks in sequence
3 ( ) 7 or more tasks in sequence
Work Speed
0 ( ) Slow rate acceptable
1 ( ) Moderate, steady pace
2 ( ) Occasional fast pace required
3 ( ) Constantly fast pace required
5.
Comments:
Comments:
FUNCTIONAL ACADEMIC SKILL REQUIREMENTS
Reading
Comments:
0 ( ) None
1 ( ) Simple words/signs/symbols
Math
2 ( ) Simple texts
3 ( ) Newspapers/magazines
Comments:
0 ( ) None
1 ( ) Simple Counting
2 ( ) Addition/subtraction/whole numbers
3 ( ) Multiplication/division/whole numbers
4 ( ) Decimal/fraction/mixed # operations
Money Skills
0 ( ) None
1 ( ) Coin/bill recognition
2 ( ) Coin/bill values
3 ( ) Money counting
4 ( ) Change making from $1
5 ( ) Change making from $10
Comments:
Writing
Comments:
0 ( ) None
1 ( ) Manuscript name
2 ( ) Cursive signature
3 ( ) Simple lists/notes
4 ( ) Phone messages
5 ( ) Letter/composition
6.
EMPLOYER CONCERNS
Employers Attitude Toward Workers with Disabilities
( ) Very Positive
( ) Indifferent
( ) Somewhat positive
( ) Negative
Comments:
Employers Financial Requirements
( ) No financial incentives requested
( ) Tax credits/incentives requested
Comments:
7.
( ) Minimum wage offered
( ) Salary below minimum wage
ENVIROMENTAL FACTORS
Safety of Work Area
( ) Safe work area
( ) Moderately safe area
( ) Some safety concerns
( ) Many safety concerns
Comments:
Atmosphere
( ) Friendly/open
( ) Busy/relaxed
( ) Slow/relaxed
( ) Unfriendly/indifferent
( ) Busy/tense
( ) Slow/tense
Cleanliness/Orderliness
( ) Very dirty/disorderly
( ) Fairly clean/orderly
( ) Very clean/neat/orderly
( ) Meticulously clean/orderly
Comments:
8.
Comments:
JOB ANALYSIS/SPECIFIC INCREMENTS OF WORK
Work Area ___________________________________
Duties_______________________________________
____________________________________________
____________________________________________
Work Area__________________________________
Duties_____________________________________
___________________________________________
___________________________________________
Task Sequence
____________________________________________
____________________________________________
Task Sequence
___________________________________________
___________________________________________
Expected Work Speed
Time in this area (in/out)
Expected Work Speed
Time in this area (in/out)
____________________________________________
____________________________________________
___________________________________________
___________________________________________
Comments:____________________________________________________________________________________
_____________________________________________________________________________________________
____________________________________________________________________________________________
Adapted from: Fadely, 1987.
JOB CHARACTERISTICS I LIKE
NAME
JOB SITE
DATE
Directions: WHAT I LIKE column: Circle the job characteristic that you like best in each box
WHAT IS HERE column: Circle the job characteristic in each box that best describes what is at this job.
MATCHES column: Circle YES if the first two columns are the same. Circle NO if they are not.
WHAT I LIKE
WHAT IS HERE
Work Alone
Lots of People Around
Quiet Workplace
Noisy Workplace
Work Close to Home
Distance to Job Doesnt Matter
Weekdays Only
Weekends Too
Easy Job
Challenging Job
Work Alone
Lots of People Around
Quiet Workplace
Noisy Workplace
Work Close to Home
Distance to Job Doesnt Matter
Weekdays Only
Weekends Too
Easy Job
Challenging Job
Dress Up for Work
Do Not Dress Up
Dress Up for Work
Do Not Dress Up
Standing Up
Sitting Down
Moving Around
Working Morning
Working Afternoons
Working Nights
Co-Workers My Age
Co-Workers Age Doesnt Matter
Thinking Work
Physical Work
Detail Important
Detail Not Important
Job Same Every Day
Job Difference Every Day
Standing Up
Sitting Down
Moving Around
Working Morning
Working Afternoons
Working Nights
Co-Workers My Age
Co-Workers Age Doesnt Matter
Thinking Work
Physical Work
Detail Important
Detail Not Important
Job Same Every Day
Job Difference Every Day
Work With People
Work With Things
Important to Work Fast
Not Important to Work Fast
Work With People
Work With Things
Important to Work Fast
Not Important to Work Fast
Little Supervision
A Lot of Supervision
Little Supervision
A Lot of Supervision
YES/NO
Work Outside
Work Inside
Work Outside
Work Inside
YES/NO
Adapted from: Martin & Marshall 1992.
MATCHES?
YES/NO
YES/NO
YES/NO
YES/NO
YES/NO
YES/NO
YES/NO
YES/NO
YES/NO
YES/NO
YES/NO
YES/NO
YES/NO
YES/NO
