Microsoft Word - Job Analysis Questionnaire

SAMPLE

Job Analysis Questionnaire

Please fill out the following questionnaire to the best of your ability. This should take

approximately an hour to complete. If you cannot complete the survey at this time, you may

return where you left off by clicking the link in your email.

For Viewing Purposes Only. Please use the electronic questionnaire sent by email to respond to these questions.

SAMPLE

Please verify your information

Employee Name:

Employee ID:

Position Number:

Current Job Title:

Job Code:

Department:

Reports to:

Date:

The information above is from HRIS, is this information accurate?

 Yes

 No

Please enter the correct information below:

 Employee Name ____________________

 Position Number ____________________

 Current Job Title ____________________

 Job Code ____________________

 Department ____________________

 Reports to ____________________

Position Status

 Full-time

 Part-time

For Viewing Purposes Only. Please use the electronic questionnaire sent by email to respond to these questions.

SAMPLE

General Instructions: The job information requested in this questionnaire should be filled

out by you, and, upon completion, the information will automatically be submitted to

your supervisor. Your supervisor will not be able to change anything you write, but they

will be able to add comments. Please focus your responses on those duties that are

considered to be a normal expectation of your position.

For Viewing Purposes Only. Please use the electronic questionnaire sent by email to respond to these questions.

SAMPLE

I-Job Purpose

The job purpose is a brief narrative picture of the job that explains why it exists. In one

sentence, explain what you do and why the job must be performed.

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SAMPLE

II-Essential Job Functions

Essential functions are accomplishments that must be achieved to call the job complete.

Please list the functions performed by your job and prioritize the importance of each

responsibility. Although there is room for 6 functions, many jobs will have fewer.

The 5-point scale measuring the importance of each responsibility begins with 'essential' and

ends with 'marginal'. Essential functions are those that are fundamental to the job. Marginal

responsibilities are those that are performed infrequently or that could be performed by others.

Functions

Priority (Select One) Description

of the

Function

Essential

Very

important

Important

Somewhat

important

Marginal

Please

describe in

a few

sentences

Function 1     

Function 2     

Function 3     

Function 4     

Function 5     

Function 6     

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SAMPLE

Please select the function that represents the primary duty of the job. The primary duty may or

may not require the most time, but represents the key reason that the job exists.

 Function 1

 Function 2

 Function 3

 Function 4

 Function 5

 Function 6

What percentage of time do you spend on each function listed above? To help you determine

percentages, think of the entire year as just one day. Of that day, what percent of time do you

spend on various duties?

______ Function 1

______ Function 2

______ Function 3

______ Function 4

______ Function 5

______ Function 6

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SAMPLE

III-Qualifications

Qualification requirements include education, experience, licensing and training required for the

job. Do not comment on your own experience, education or licensing, rather indicate the

minimum level required to perform the essential job functions.

What is the typical level of formal education required for your position?

 Less than high school

 High school or equivalent

 Two year college or technical degree

 Four-year college degree or higher

Please specify the field of study or degree related to the level of formal education selected

above:

What number of years of experience related to the current job do you believe is necessary for

an employee entering the position?

 1 year or less

 More than 1 year up to 3 years

 More than 3 years up to 5 years

 More than 5 years up to 10 years

 More than 10 years

Are there any special certification, licenses and/or accreditation that are required for your

position?

 No licenses, certification or accreditation required for this position

 Licenses, certification or accreditation required. Please provide detail:

____________________

Does your position require any additional training or specific experience to perform the essential

functions? If yes, please describe.

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SAMPLE

IV-Knowledge, Skills & Abilities

Identify any specific knowledge, skills and/or abilities required to perform the essential

functions of this job that have not been documented already in this questionnaire.

Knowledge, Skill or Ability: Please describe how this

knowledge, skill or ability is

applied on the job:

Example: Ability to operate

office machines (i.e.,

photocopier, fax machine,

telephone).

Operate photocopier, fax and

telephone to direct incoming

calls and perform basic

secretarial duties for the

department.

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SAMPLE

V-Reporting Relationships

Please select the statement that best describes your supervisory responsibility. Supervisory

responsibility is defined as duties associated with personnel actions.

 I do not supervise anyone

 I am a lead worker. I give input to my supervisor regarding other employees' performance,

but I do not make hiring and firing recommendations.

 I have primary responsibility for conducting performance evaluations and making

recommendations for hiring and firing employees.

Please indicate the number of individuals you directly supervise:

Please indicate the number of individuals who report to a supervisor reporting to you:

Do you manage a department or division?

 Yes

 No

Do you have the authority to hire and fire employees?

 Yes

 No

If you do not have the absolute authority to hire and fire, are your recommendations sought and

given serious consideration?

 Yes

 No

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SAMPLE

VI-Problem Solving

Kinds of problems I see

 The problems in my job usually come up again and again.

 The problems in my job are somewhat varied, but often routine.

 The problems in my job are varied.

 The problems that come to me are usually the ones that other employees have not been

able to handle.

How I solve problems

 I have to check with my supervisor before I do anything other than what the established

procedure states.

 I check with my supervisor if none of the usual alternatives fit the situation.

 I get help from my supervisor or others in handling unusual problems.

 I need to come up with the solution.

Please list examples of problems that you frequently solve as part of your job. Then tell us what

you use to fix the problem.

Problems What do you rely on to solve the problem?

. Policies Manuals Procedures Rules

Independent

Judgement

1     

2     

3     

If you'd like to describe the policies and procedures you use to solve problems, please do so

below.

Please select the statement that best describes the information you need to rely on to solve

problems.

 Specific information is immediately available and usable, such as a manual or established

policies and procedures.

 Specific information is normally available and in a readily usable form.

 General information is normally available. Specific information usually has to be sought

elsewhere.

 Information may be incomplete or in a form not readily usable. Specific information almost

always needs to be sought elsewhere to fill in gaps.

 Information is often vague or misleading. Specific information, if available, almost always

needs to be sought elsewhere.

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SAMPLE

VII-Decision Making

When you make a decision in your job, who does it affect? Complete the following sentence by

checking the appropriate box(es).

When I make a decision, it primarily affects:

 My work.

 The work of others in my work group.

 The work of others in my department.

 Others in work areas outside my department.

 The public.

Please describe decisions that you are responsible for making and that you are held

accountable for the result.

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SAMPLE

VIII-Consequences of Error

Please provide examples of typical errors that could be made in your job. (Please consider

these errors when responding to the following two questions.)

Who would catch the errors and how long would it take to detect? (Please respond in

consideration of the errors described in the question above.)

What is the approximate cost of money, time and/or effort it would take to correct the

errors? Please also include the harm or hardship that the errors may cause other

individuals. (Please respond in consideration of the errors described in the question above.)

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SAMPLE

IX-Work Environment

How much on-the-job time is spent in the following PHYSICAL ACTIVITIES? Show the amount

of time by checking all applicable responses below.

Time spent on activity Specific

Examples

Never

(0%)

Rarely (up

to 15%)

Occasionally

(16%-40%)

Frequently

(41%-70%)

Regularly

(over 70%)

Sitting     

Talking     

Hearing     

Feeling

attributes of

objects

    

Grasping     

Pushing     

Standing     

Walking     

Driving     

Reaching

with

hands/arms

    

Stooping,

kneeling,

crouching,

crawling

    

Climbing or

balancing

    

Repetitive

wrist, hand

and/or

finger

movement

    

Operate

mechanical

equipment

    

Moving up

and down

from/to

sitting

position on

the floor

    

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SAMPLE

Identify which VISUAL ACTIVITIES are usually required during a typical workday in order to

accomplish the essential functions of this position. Indicate all applicable responses.

 Clarity of vision at 20 feet or more.

 Clarity of vision at 20 inches or less.

 Three-dimensional vision--ability to judge distance and space relationships.

 Precise hand-eye coordination.

 Ability to identify and distinguish colors.

Describe specific examples of visual activities.

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SAMPLE

Does this job require exposure to any of the following ENVIRONMENTAL

CONDITIONS? Please select the amount of time spent in each environmental condition and

indicate which job duties are affected by the condition(s).

Time spent on activity Specific

Examples

Never

(0%)

Rarely (up

to 15%)

Occasionally

(16%-40%)

Frequently

(41%-70%)

Regularly

(over 70%)

Work in

confined

spaces

    

Wet, humid

conditions

(non-

weather)

    

Varying,

inclement

outdoor

weather

conditions

    

Vibration     

Work in

hazardous

traffic

conditions

    

Extreme

cold (non-

weather)

    

Extreme

heat (non-

weather)

    

Subject to

oils

(mechanical

or food)

    

Required to

wear a

respirator

    

Fumes or

airborne

particles

    

Work near

moving

mechanical

parts

    

Work in     

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SAMPLE

high,

dangerous

places

Risk of

electrical

shock

    

Potentially

hazardous

bodily fluids

    

Potentially

hazardous

or cancer-

causing

agents or

chemicals

    

How much NOISE is experienced daily in the work environment of this job? Check the

appropriate level below.

 Very quiet.

 Quiet.

 Moderate noise (i.e., an office with computers, photocopiers and/or computer printers).

 Loud noise. Please describe: ____________________

 Very loud noise. Please describe: ____________________

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SAMPLE

Does this job require that WEIGHT is lifted or FORCE is exerted? If so, how much and how

often? Check all applicable responses below.

Time spent on activity Specific

Examples

Never

(0%)

Rarely (up

to 15%)

Occasionally

(16%-40%)

Frequently

(41%-70%)

Regularly

(over 70%)

Up to 1

pound

    

2-5 pounds     

6-10

pounds

    

11-15

pounds

    

16-20

pounds

    

21-25

pounds

    

26-30

pounds

    

31-35

pounds

    

36-40

pounds

    

41-45

pounds

    

46-50

pounds

    

51-75

pounds

    

76-100

pounds

    

100+

pounds

    

Identify the level of attention that is usually required during a typical workday in order to

accomplish the <strong>essential functions</strong> of this position.

 Normal attention.

 Frequent attention (typical examples include paying bills, posting journal entries, etc.)

 Concentrated attention.

 Extremely demanding attention (typical examples include high-level managerial

responsibilities).

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SAMPLE

Describe specific examples of mental activities. (i.e. how do you discover, analyze, and solve

problems?)

Please describe any other working conditions that have not been identified that are applicable to

this position.

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SAMPLE

Before you submit this questionnaire, please carefully read the statement below and indicate

you have read it by typing your full name in the box below. Once you hit submit, the

questionnaire will go to Human Capital Services (HCS) and will then be submitted to your

supervisor for review.

Accurate information is needed in order to fairly and equitably create job descriptions and

compare these job descriptions to market data. I certify that this accurately reflects my job

duties and essential functions. I understand that audits may take place, and inaccurate

reporting will result in a delay of the evaluative process.

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