Steward Café

I certify that I have read the physical requirements as set forth below and am physically able to perform the necessary duties as indicated herein.

Employee Signature : _________________________ Date: _____________

Please check ALL physical activities that apply to the essential functions of the position:

☒ A. Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.

☒ B. Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.

☒ C. Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.

☒ D. Kneeling: Bending legs at knee to come to a rest on knee or knees.

☒ E. Crouching: Bending the body downward and forward by bending leg and spine.

☐ F. Crawling: Moving about on hands and knees or hands and feet.

☒ G. Reaching: Extending hand(s) and arm(s) in any direction.

☒ H. Standing: Particularly for sustained periods of time.

☒ I. Walking: Moving about on foot to accomplish tasks, particularly for long distances or moving from one work site to another.

☒ J. Pushing: Using upper extremities to press against something with steady force in order to thrust forward, downward or outward.

☒ K. Pulling: Using upper extremities to exert force in order to draw, drag, haul or tug objects in a sustained motion.

☒ L. Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position-to-position. This factor is important if it occurs to a considerable degree and requires the substantial use of the upper extremities and back muscles.

☒ M. Fingering: Picking, pinching, typing or otherwise working, primarily with fingers rather than with the whole hand or arm as in handling.

☒ N. Grasping: Applying pressure to an object with the fingers and palm.

☒ O. Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.

☒ P. Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.

☒ Q. Hearing: Perceiving the nature of sounds at normal speaking levels or without correction. Ability to receive detailed information through oral communication and make fine discriminations in sound.

☒ R. Repetitive Motions: Substantial movements (motions) of the wrists, hands, and/or fingers.

Please check the ONE description of visual acuity requirements (including color, depth perception, and field of vision), that best describes the requirements of the position:

☐ A. The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; expansive reading; visual inspection involving small defects, small parts and/or operation of machines (including inspection); using measurement devices; and/or assembly of fabrication of parts at distances close to the eyes.

☐ B. The worker is required to have visual acuity to perform an activity such as: operating machines such as lathes, drill presses, power saws and mills where the seeing job is at or within arm's reach; performing mechanical or skilled trades tasks of a non-repetitive nature such as carpenters, technicians, service people, plumbers, painters, mechanics, etc.

☐ C. The worker is required to have visual acuity to operate motor vehicles or heavy equipment.

☒ D. The worker is required to have visual acuity to determine the accuracy, neatness, thoroughness of work assigned (i.e., custodial, food services, general labor, etc.) or to make general observations of facilities or structures (i.e., security guard, inspection, etc.)

Please check ALL conditions the worker is subject to in performing the essential functions of the position:

☐ A. The worker is subject to inside environmental conditions: Protection from weather conditions but not necessarily from temperature changes.

☐ B. The worker is subject to outside environmental conditions: No effective protection from the weather.

☒ C. The worker is subject to both environmental conditions: Activities occur inside and outside.

☒ D. The worker is subject to extreme cold: Temperatures typically below 32 degrees for periods of more than one hour. Consideration should be given to the effect of other environmental conditions such as wind and humidity.

☐ E. The worker is subject to extreme heat: Temperatures above 100 degrees for periods of more than an hour. Consideration should be given to the effect of other environmental conditions such as wind and humidity.

☐ F. The worker is subject to noise: There is sufficient noise to cause the worker to shout in order to be heard above the ambient noise level.

☐ G. The worker is subject to vibration: Exposure to oscillating movements of extremities or whole body.

☐ H. The worker is subject to hazards: Includes a variety of physical conditions, such as proximity to moving mechanical parts, moving vehicles, electrical current, working on scaffolding and high places, exposure to high heat or exposure to chemicals.

☐ I. The worker is subject to atmospheric conditions: One or more of the following conditions that affect the respiratory system of the skin: Fumes, odors, dust, mists, gases or poor ventilation.

☐ J. The worker is subject to oils: There is air and/or skin exposure to oils and other cutting fluids.

☐ K. The worker is required to wear a respirator.

☐ L. The worker frequently is in close quarters, crawl space, shafts, manholes, small, enclosed rooms, small sewage and water line pipes, and other areas which could cause claustrophobia.

☐ M. The worker is required to function in narrow aisles or passageways.

☐ N. The worker is exposed to infectious diseases.

☐ O. The worker is required to function around prisoners or mental patients.

☐ P. None: The worker is not substantially exposed to adverse environmental conditions (such as in typical office or administrative work).