Transcription of C545 EMPLOYER - PHYSICAL DEMANDS ANALYSIS
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C545 EMPLOYER - PHYSICAL DEMANDS ANALYSIS
C-545 REV AUG 2019 Page 1 C545 EMPLOYER - PHYSICAL DEMANDS ANALYSISC laim Number:Worker s Surname:Given Name:Initial:Job Title:Hours per shift:Shifts per week/shift rotation:Company NameEmployer ContactTelephone NumberManual Handling Tasks Description of objects handled [Weight/force (lb)]FREQUENCY OF WORKDAY / SHIFTNot RequiredRare1 5% Occasional6 33% Frequent34 66%Constant67 100%Place the heaviest weight / force handled into the appropriate Low Level LiftingBox of 24 bottles of water (18 lb), bag of cement mix (66 lb)66 lb18 lbLow Level LiftingWaist Level LiftingAbove Shoulder LiftingFront Carry Side Carry Shoulder PushingSweeping floors, securing loads with a snipe, moving a loaded skid with a pallet jackHeavyforceLight forcePushing(stationary and walking)Pulling(stationary and walking)Positional TasksDescription of activity completedCheck appropriate Forward BendingShoveling gravel, sweeping floors, picking up garbage, washing vehicles with pressure washerSitting/Driving(type of seat/chair)
EMPLOYER - PHYSICAL DEMANDS ANALYSIS Claim Number: Worker’s Surname: Given Name: Initial: Job Title: Hours per shift: Shifts per week/shift rotation: CompanyName Employer Contact Telephone Number Manual Handling Tasks Description of objects handled [Weight/force (lb)] FREQUENCY OF WORKDAY/ SHIFT Not Required Rare 1–5% Occasional 6–33% ...
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