JOB ANALYSIS FORM

PARTICIPANT	____________________________________	JOB TRAINER ________________________________________

COMPANY _________________________________________ 	CO. PH.ONE  _________________________________________

ADDRESS __________________________________________ 	CONTACT____________________________________________

DATE JOB BEGINS __________________________________  	SITE _________________________________________________
          
JOB TITLE                                                                                     	IMMED SUPERVISOR__________________________________

PROJECT YEAR _____________________________________

CORE WORK TASKS:
(Identified by employer)	EPISODIC WORK TASKS:
(Identified by employer)	

		
JOB-RELATED TASKS:
(Identified during Job Negotiation)	IMPORTANT CULTURAL ASPECTS: 
(Possible accommodations based on info in Profile)	

		
JOB DETAILS: ______________________________________________________________________________________________________________________________________________________________________________________________________

RATE OF PAY:  __________	HOURS PER WEEK:  __________		WORK DAYS:  __________
BENEFITS: ____________________________________________________________________________________
HOLIDAYS/LEAVE TIME: _____________________	BREAKS/LUNCH: ___________________________
WORK HOURS EACH DAY: ____________________	OVERTIME/WEEKEND: _____________________
ATTACH JOB SUMMARY ON SEPARATE SHEET

I.  THE WAY IN WHICH THE JOB TASKS ARE TYPICALLY PERFORMED:

A.	Method:  The facilitator should observe the manner in which typical employees in the setting perform each job.  This is accomplished by assuming an unobtrusive observation position and carefully watching the employee(s) perform their duties.  The facilitator should strive to make a "mental video tape" to be used later as a standard of correct performance and as a way to assist the supported employee to perform in a natural manner.

	Job observed			Employee Observed		Date & Time

1.

2.

3.

4.

5.

B.	Content:  The employment facilitator should ask if the employer has step-by-step procedures for the job tasks observed above.  If so, these procedures should serve as the initial content task analysis for each task.  If not, the facilitator should write content steps, which would be appropriate for an average employee in the work site.  These content steps should be presented to an appropriate decision-maker in the company for approval and refinement.  Attach step-by step-procedures to this form.

Specific Requirements Identified by Employer (Check only critical items; fully describe the extent of the demand and outline possible adaptations/accommodations it felt to be problematic for targeted employee)

PHYSICAL DEMANDS:	SENSORY/COMMUNICATION DEMANDS:
	
Lifting                      		Vision		
Standing   		Hearing		
Continuous Movement   		Speaking		
Rapid Movement		Judgment		
Walking		ACADEMIC DEMANDS:	
Climbing		Reading		
Stooping		Writing		
Crawling		Math		

C.	GENERAL STRENGTH/ENDURANCE REQUIREMENTS:

D.	PACE OF WORK:

E.	POTENTIALLY DANGEROUS COMPONENTS OF JOB:

F.	CRITICALLY IMPORTANT COMPONENTS OF JOB:

G.	ESTABLISHED LEARNING CURVE OR PROBATIONARY PERIOD FOR JOB:

H.	WORK SITE CONSIDERATIONS (SPECIAL CLOTHING, UNIFORMS, SAFETY EQUIPMENT REQUIRED):

I.	TOOLS TO BE USED:

J.	EQUIPMENT TO BE OPERATED:

K.	MATERIALS TO BE HANDLED:

L.	SPECIAL TERMS USE AT WORK SITE:

M.	DESCRIPTION OF ENVIRONMENTAL CONDITIONS OF WORK SITE:

II.	THE MEANS USED BY THE EMPLOYER TO TRAIN AND SUPPORT NEW EMPLOYEES

A.	DESCRIPTION OF THE COMPANY'S ORIENTATION PROCEDURES:  Ask to review any written documents, which describe typical orientation procedures.  Discuss with a supervisor or decision-maker the flow of typical procedures.  Ask employees about their experiences.  If possible, and if it is felt to be necessary, ask to be taken through an orientation.

B.	DESCRIPTION OF THE COMPANY'S PROCEDURES FOR INITIALLY TRAINING AND SUPPORTING NEW EMPLOYEES:  Follow the suggestions in IIA, above.  Additionally, ask for training from the employer on at least one of the tasks to be performed by the supported employer.  Use this training as an opportunity to assess the capacity and flexibility of the employer in reference to the needs of the supported employee.

C.	DESCRIPTION OF SPECIFIC STRATEGIES USED BY THE EMPLOYER

	1.	WHO TYPICALLY PROVIDES NEW EMPLOYEES WITH TRAINING?

	2.	AVAILABILITY OF COMPANY TRAINER ASSIGNED TO EMPLOYEE:

3.	AVAILABILITY OF CO‑WORKERS/SUPERVISORS AS TRAINERS:

	4.	DESCRIPTION OF STRATEGIES USED BY EMPLOYER:

	5.	IMPORTANT RULES STRESSED BY EMPLOYER & CO-WORKERS:

	6.	UNWRITTEN RULES UNIQUE TO THE SETTING:

7.	POTENTIAL FOR USE OF ADAPTATIONS, MODIFICATIONS IN WORK SITE:

	
	8.	WILLINGNESS OF CO‑WORKERS/SUPERVISORS TO PROVIDE SUPPORT AND ASSISTANCE:

D.	THE "CULTURE" OF THE WORK SITE

	1.	EMPLOYER'S CONCERN FOR QUALITY:

	2.	EMPLOYER'S CONCERN NEED FOR PRODUCTIVITY:

	3.	FLEXIBILITY/RIGIDITY OBSERVED:

III.  PERSONNEL: MANAGERS, SUPERVISORS, AND CO-WORKERS

A.	SUPERVISORS OF EMPLOYEE

1.	 ________________________________	TITLE _____________________	

	2. ________________________________	TITLE _____________________

B.	CO-WORKERS OF EMPLOYEE

	1. _______________________________	POSITION ______________________

	2. _______________________________	POSITION ______________________

	3. _______________________________	POSITION ______________________ 

	4. _______________________________	POSITION ______________________

C.	EMPLOYEE SOCIAL GROUPS AND NON-WORK ACTIVITIES:

D.	LEADERS AND POTENTIAL ALLIES AMONG CO-WORKERS AND SUPERVISORS:

IV.  JOB DESCRIPTION

A.	SCHEDULE:
# OF DAYS OF WORK PER WEEK ___________________________

DAYS: ___________________________ 		HRS_________‑ _________

	___________________________		HRS_________‑ _________  

		___________________________     	HRS_________‑ _________
	 
		___________________________    	HRS_________‑ _________
 
		___________________________   		HRS_________‑ _________

B.	SEQUENTIAL CHRONOLOGY OF TYPICAL WORK DAY:  (Include all job tasks)

1.	TYPE OF JOB TASK (Core, episodic, job‑related)__________________________________
___________________________________________________________________________
___________________________________________________________________________

2.	NAME OF JOB TASK ________________________________________________________ 

3.	HOW OFTEN PERFORMED: __________________________________________________

4.          CONTENT STEPS/SKILLS, STRATEGY FOR FACILITATION
		Including instructional and natural cues and adaptations)