CLINICAL AND LAB ACTIVITY INFORMATION
Job Title: Student
Department: Medical Sonography __
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JOB REQUIREMENTS |
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Occasional |
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Frequent |
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Constant |
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Activity: |
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(LIST # OF LBS) |
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Lifting |
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Static Knuckle height |
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ü |
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Bench height |
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ü |
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Ankle height |
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ü |
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Shoulder height |
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ü |
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Dynamic Bench height |
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To the Left |
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ü |
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From the Center |
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ü |
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To the Right |
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ü |
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Dynamic Shelf height |
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To the Left |
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ü |
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From the Center |
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ü |
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To the Right |
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ü |
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Carrying |
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ü |
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Cart height Pushing |
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ü |
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Pulling |
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ü |
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Shoulder height Pushing |
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ü |
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Pulling |
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ü |
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List frequency only: |
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Sitting |
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ü |
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Standing/Walking |
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ü |
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Climbing Stairs |
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ü |
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Ladder |
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ü |
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Balance (type: ) |
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ü |
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Stooping |
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ü |
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Kneeling |
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ü |
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Crouching |
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ü |
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Crawling |
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ü |
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Reaching Forward |
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ü |
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Overhead |
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ü |
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Bended reach |
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ü |
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Other: |
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Handling |
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ü |
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Fingering |
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ü |
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Feeling |
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ü |
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Talking |
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ü |
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Hearing (type: ) |
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ü |
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Seeing Near |
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ü |
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Distant |
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ü |
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Reading |
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ü |
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Calculating |
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ü |
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Compiling |
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ü |
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Lifting Frequencies: Other Activities:
Occasional: 1 lift every 30 minutes Occasional: 0 - 33% ( 0-20 min. per hour)
Frequent: 1 lift every 2 minutes Frequent: 34 - 66% (21-40 min. per hour)
Constant: 1 lift every 15 seconds Constant: 67 - 100% (41-60 min. per hour)
CLINICAL AND LAB ENVIRONMENT INFORMATION
Job Title: Student
Department: Medical Sonography
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Never |
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Occasional |
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Frequent |
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Constant |
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Indoors |
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ü |
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Outdoors |
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ü |
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Temperature: |
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Hot |
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ü |
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Moderate |
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ü |
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Constant |
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ü |
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Humid / Damp |
ü |
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Dust |
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ü |
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Hazardous Chemicals |
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ü |
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Steps, Ramps, Stairs |
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ü |
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Slippery or Uneven |
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Walked Surfaces |
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ü |
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Irregular Work Hours |
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ü |
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Departmental Mobility |
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Barriers |
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ü |
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Hazardous Working |
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Conditions |
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ü |
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Lifting Frequencies: Other Activities:
Occasional: 1 lift every 30 minutes Occasional: 0 - 33% ( 0-20 min. per hour)
Frequent: 1 lift every 2 minutes Frequent: 34 - 66% (21-40 min. per hour)
Constant: 1 lift every 15 seconds Constant: 67 - 100% (41-60 min. per hour)
CLINICAL AND LAB WORK PLACE INTERACTIONS
Job Title: Student
Department: Medical Sonography
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Never |
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Occasional |
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Frequent |
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Constant |
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Communicating |
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ü |
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Interpreting |
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ü |
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Investigating |
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ü |
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Explaining |
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ü |
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Planning |
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ü |
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Supervising |
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ü |
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Teamwork |
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ü |
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Work Controlled by |
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Supervisor |
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ü |
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Day - to - day |
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Supervision |
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ü |
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Lifting Frequencies: Other Activities:
Occasional: 1 lift every 30 minutes Occasional: 0 - 33% ( 0-20 min. per hour)
Frequent: 1 lift every 2 minutes Frequent: 34 - 66% (21-40 min. per hour)
Constant: 1 lift every 15 seconds Constant: 67 - 100% (41-60 min. per hour)
I, as a prospective student have read and understand
(Please Print)
the job description and job activity information.
Signed:
Date:
Witness:
Title:
Back to Allied Health Programs