group retrospective rating program job analysis...

An Association of Not-For-Profit and Mission Focused Senior Living & Care Providers 1495 Wilmington Drive, Suite 340 | DuPont, WA 98327 | 253-964-8870 | 253-964-8876 Fax | www.agingwa.org

Group Retrospective Rating Program

Job Analysis Handbook

Updated December 2011

Provided in Conjunction with our Group Retro Program Claims Administrator

Phone: (425) 252-7623 www.compriskmgt.com

Job Analysis Handbook Updated December 2011

Table of Contents

Assistant Site Manager .................................................................................................................. 1

Cashier ........................................................................................................................................... 5

Community Site Manager ............................................................................................................ 10

Cook-Helper ................................................................................................................................. 14

Daycare Worker ........................................................................................................................... 19

Dietary Cook ................................................................................................................................ 24

Dishwasher ................................................................................................................................... 29

Driver ........................................................................................................................................... 34

Feeder-Bedmaker ......................................................................................................................... 38

Homemaker .................................................................................................................................. 43

Housekeeper – Assisted Living ................................................................................................... 48

Housekeeper – Nursing Home ..................................................................................................... 52

Housekeeper ................................................................................................................................. 56

Kitchen Aid .................................................................................................................................. 60

Laundry Worker – Nursing Home ............................................................................................... 65

Licensed Practical Nurse (LPN) - Wellness Nurse - Assisted .................................................... 70

Licensed Practical Nurse (LPN) – Primary Care – Nursing Home ............................................ 75

Maintenance ................................................................................................................................. 80

Medical Records Clerk ................................................................................................................ 84

Nurse Assistant Certified (NAC) - Nursing Home ...................................................................... 89

Physical Therapy Assistant .......................................................................................................... 94

Receptionist.................................................................................................................................. 99

Recreation-Activities Therapy Assistant ................................................................................... 104

Registered Nurse (RN) - Wellness Nurse - Assisted Living ...................................................... 109

Registered Nurse (RN) - Primary Care – Nursing Home .......................................................... 114

Residential Service Associate (RSA) - Assisted Living ............................................................ 119

Security Guard ........................................................................................................................... 124

Stock Clerk................................................................................................................................. 129

Transitional Work Options ........................................................................................................ 134

Wait Person ................................................................................................................................ 138

Zero Lift NAC............................................................................................................................ 143

Please return correspondence to: ❒ Strategic Consulting Services, Inc. 33434 8th Ave. S., Ste 205 9th Avenue Pavilion Building Federal Way, WA 98003-6323 (253) 661-5550 (206) 203-0057 [fax]

❒ Strategic Consulting Services, Inc. 2617 12th Court SW Building A Olympia WA 98502-1023 (253) 661-5550 (360) 786-8045 [fax]

JOB ANALYSIS

Worker: _____________________

Claim No: ___________________ Job Title: Assistant Site Manager DOT Title: Manager, Apartment House DOT: 186.167-018 GOE: 11.11.01 SVP: 5 Industry: 731 Real Estate Employer: __________________________ C/O Comprehensive Risk Management

ATTN: Pamela Kaye Dooner 1520 Broadway, Suite 201 Everett, WA 98201

Contact Person: Pamela Kaye Dooner Phone Number: 425.252.7623 Analyst: Stacy Lough, CDMS; Janet Snyder, CDMS Date: November 18, 2011 Job Description: Assist Site Manager in performing the daily duties and responsibilities related to the successful operation of the property. Assistant Site Managers live on-site. (Essential job tasks prioritized below)

1. Shows prospective tenants apartments and explains occupancy terms. 2. Informs prospective tenants of availability of nearby schools, shopping malls, recreational facilities, and public

transportation. 3. Rents or leases apartments, collects security deposit as required, and completes lease form outlining conditions

and terms of occupancy when required. 4. Collects rents due and issues receipts. Issues late notices and follows up on delinquencies. 5. Investigates tenant complaints concerning malfunctions of utilities or furnished household appliances or goods,

and inspects vacated apartments to determine need for repairs or maintenance. 6. Directs and coordinates activities of maintenance staff engaged in repairing plumbing or electrical malfunctions,

painting apartments or buildings, and performing landscaping or gardening work, or arranges for outside personnel to perform repairs. Directs and coordinates the driver and housekeeping.

7. Resolves tenant complaints concerning other tenants or visitors. Job Qualifications and Skills: High School education and a minimum of one year experience as an Assistant Site Manager or related field; knowledge of or training in LIHT (Section 42) compliance; knowledge of computers and basic software application including Word, Excel, Outlook and where appropriate, property management software (e.g. AMSI);

Claim No: ____________________

Worker: ______________________ Job Analysis: Assistant Site Manager

DOT No: 186.167-018 Page 2

ability to work with other employees and address resident concerns in a professional manner; the ability to comprehend and perform all responsibilities of the position; able to assist in performing the duties of the Site Manager in his/her absence; neat, clean and professional appearance; legible handwriting; valid driver’s license and operational vehicle. High School Diploma/GED Required: Yes College Degree: None WA State Driver’s License: Yes Special Endorsements: None Clean Driving Record/Insurable: Yes Basic Computer Skills: Yes Speak/read/write English: Yes Keyboard Speed Required: None Software (name/version): Word, Excel, Outlook Permits/Certifications: None Type of Computer: PC Computer Operating System: Windows XP Licensure: N/A Other:

Type of Machines, Tools, Special Equipment Used: PC Computer, printer, facsimile, copier, standard office supplies. Work Schedule: Full time – 40+/hrs per week

PHYSICAL DEMANDS

N: Never (not at all) F: Frequent (34%-66% of the time)

S: Seldom (1-10%) C: Constant (67%-100% of the time)

O: Occasional (11-33% of the time)

STRENGTH: Sedentary Light Medium Heavy Very Heavy

Stand: OCASIONALLY when assisting current residents with questions and concerns. Standing occurs on carpet, tile, vinyl and concrete surfaces. Stand and walk are intermittent throughout the shift with static standing limited to under 5 minutes in duration. Walk: OCCASIONALLY when meeting prospective residents and showing the community. Walking occurs on carpet, tile, vinyl and concrete surfaces. Stand and walk are intermittent throughout the shift with walking lasting up to 30 minutes when providing tours to prospective clients or hanging notices/flyers. As needed, may walk throughout the facility to post notices on doors. Sit: FREQUENT to CONSTANT in on-site office when providing management and assistance to residents - documenting concerns, answering questions, collecting rents, preparing marketing materials, etc. Sitting occurs in a swivel office chair. Lift: OCCASIONALLY lift items weighing less than 5 pounds, to include a telephone receiver, folders, files and a ream of paper. SELDOM lifting up to 20 pounds may be necessary for supplies. Carry: OCCASIONALLY up to 5 pounds for distances of up to 10 feet to obtain office supplies from the supply area (i.e. staples, a ream of paper, etc.). Rubbermaid carts are used to move larger and heavier items/boxes throughout the facility as needed for holiday decorations and supplies. Push/Pull: OCCASIONALLY with less than 5 pounds of force for normal daily operations of opening/closing drawers and doors. SELDOM may push cart with supplies less than 10 pounds force. Climb: Ladders: Not a required physical demand of this position.

Claim No: ____________________


DOT No: 186.167-018 Page 3

Stairs: Resident buildings have elevators available. Stairs are also available for emergency and for use at employee’s discretion.

Crawl: Not a required physical demand of this position. Bend/Stoop: OCCASIONALLY with a limited degree of flexion to reach lower shelves and bottom drawer of filing cabinets. This is done from a seated position in an office swivel chair. Crouch/kneel can often be used in lieu of bend/stoop at the worker’s discretion. Crouch/Kneel: See Bend/Stoop. Twist: Not a required physical demand of the position at torso and neck level. The worker can avoid all twisting at these levels by positioning the feet/body relative to the task being performed and utilizing the swivel office chair. Handle/Grasp: Simple grasping techniques requiring less than two pounds of force are used OCCASSIONALLY when answering phones, utilizing a computer mouse or supplies. Handling and grasping may occur bilaterally or unilaterally. Fine Manipulation/Fingering: OCCASIONALLY to FREQUENTLY when using phone and keyboard for emails/calls to residents, Corporate Office, outside public and outreach. Reach: OCCASIONALLY reach from thigh level to shoulder level for supplies around desk area. SELDOM reach below thigh level or above the shoulders when accessing cabinets for supplies. Reaching below thigh level and above shoulder level may be performed unilaterally or bilaterally. Vision/Talk/Hearing: Normal or corrected to normal vision and hearing are required to identify and communicate with residents and work on the computer. Taste/Smell: Required on occasion when verifying cleanliness for ‘move outs’, safety; and evaluating complaints. Environmental Factors/Access: Work is performed inside a climate controlled building. Florescent and natural lighting are utilized. Depending on daily tasks, may be exposed to inclement weather moving between buildings (up to a maximum of 150 feet). Work Environment Access: Parking and restroom facilities are available.

Note: This description represents the requirements of the job based on personal observations, discussions with the employer representatives, incumbents and other professional resources. On occasion, practicality and feasibility prevent the direct observation and/or gathering of objective, quantifiable data. For this reason, a “best estimate” may have been used.

Claim No: ____________________


DOT No: 186.167-018 Page 4

PHYSICIAN:

I agree that the above name injured worker can perform the physical activities described in this job analysis and can return to work. State date worker is released to return to work if different from today’s date ________________.

I agree the injured worker can perform the described job but only with modifications (describe in comments

section). Modifications are needed on a permanent or temporary basis.

The above-named injured worker temporarily cannot perform this job based on the following physical limitations.

Anticipated release date: Treatment plan:

The above named injured worker is permanently restricted from performing the physical activities described in this job analysis based on the following limitations (state objective medical findings):

Comments: Attending Physician Date

Please return correspondence to: Strategic Consulting Services, Inc. 33434 8th Ave. S., Ste 205

9th Avenue Pavilion Building Federal Way, WA 98003-6323

(253) 661-5550 (206) 203-0057 [fax]

Strategic Consulting Services, Inc. 2617 12th Ct. SW Building A Olympia, WA 98502-1023

(253) 661-5550 (360) 786-8045 [fax]

JOB ANALYSIS

Worker: Claim No:

Job Title: Cashier DOT: 211.462-010 DOT Title: Cashier II GOE: 07.03.01 SVP: 2 Location:

C/O Comprehensive Risk Management ATTN: Pamela Kaye Dooner 1520 Broadway, Suite 201 Everett, WA 98201

Contact Person: Pamela Kaye Dooner Phone Number: (425) 252-7623 Analyst: Janet Snyder Date: 9/13/06

In describing various physical demands, the categories below are used to classify the

frequency of an activity as a percentage of the work day. These categories are defined as follows:

OCCASIONALLY (O) - 0-33% of the work day FREQUENTLY (F) - 34-66% of the work day CONSTANTLY (C) - 67-100% of the work day (Per United States Department of Labor, "The Revised Handbook for Analyzing Jobs,"

U.S. Government Printing Office, Washington, D.C., 1991. (See Handbook for definitions.)

Claim No: __________________ Worker:__________________ Job Analysis - Cashier

DOT No.: 211.462-010 Page 2 Job Description: (Essential job tasks prioritized below.) Required to ring up cost of food on cash register, take payments, return change and balance register at end of the day. May be required to assist residents to table. Required to carry money from facility to dining area and confirm amount. Required to take money from residents or guests and return change. Required to count money at end of shift to check for errors. Competencies required to perform the job include: Dealing with people: Work situations that involve interpersonal relationships in a job setting beyond giving and receiving work instructions. Attaining Precise Set Limits, Tolerances, and Standards: Work situations that involve adhering to and achieving exact levels of performance, using precision measuring instruments, tools, and machines to attain precise dimensions. Preparing exact verbal and numerical records. Complying with precise instruments and specifications for materials, methods, procedures, and techniques to attain specified standards. Job Qualifications: Types of Machines, Tools, Special Equipment Used: Cash register Materials, products, subject matter, services: 880, Merchandising Services Industry Designation: 249, Clerical and Kindred Work Schedule:

PHYSICAL DEMANDS Strength Level: Light Stand: Standing and walking are performed for up to two hours at a time during the work day. Walk: Standing and walking are performed for up to two hours at a time during the work day. Sit: Sitting is performed for two hours at a time, up to four hours per day while performing cashier duties. A stool or chair can be provided. The worker is able to alternate sitting and standing as necessary or medically recommended. Lift: Frequently lift items such as coins and money weighing up to 10 pounds. Occasionally may be required to lift up to 20 pounds such as the till and money at the end of the day. Lifting over 20 pounds is not required. Lifting is up to a maximum of 20 pounds, consisting of the cashier's till and money at the end of the day. Carry: Occasionally may be required to carry money and change up to 100 feet at one time to and from the cashier area. Occasionally at the end of the day would be required to carry the till weighing up to a maximum of 20 pounds for 100 feet. Carrying over 20 pounds is not required.


DOT No.: 211.462-010 Page 3 Push: May use minimal push/pull force to open and close the cash register drawer. Pull: May use minimal push/pull force to open and close the cash register drawer. Controls: Foot controls are not used in this position. Hand controls are used on the cash register. Climb: Climbing is not a requirement of this position. Balance: Balance is needed in relation to standing, walking and sitting while performing this position. Bend/Stoop: Rare bending at the waist may be performed. Crouch: Rare crouching may be performed to pick up items dropped. Twist: Twisting at the waist or neck is not a requirement of this position. Kneel: Rare kneeling may be performed to pick up items dropped. Crawl: Not a requirement of this position. Handle/Grasp: Constant handling and grasping money. Fine Manipulation/Fingering: Frequent fingering when using the cash register to add up purchases and count coins. Feeling: Not a requirement of this position. Reach: Reaching above shoulder height is not required. Reaching at shoulder height is frequently required to hand change and take money from residents and families. Reaching below shoulder level may be required to pick up items that have dropped on the floor. Vision: Normal to correctable vision is necessary for doing the job effectively and correctly. Talk/Hear: Talking/hearing is necessary for communicating with others and for taking instructions from others. Taste/Smell: Not a requirement of this position. Environmental Factors: Temperature controlled, 100% of the work shift is performed indoors. No exposure to chemicals. Whole body vibration and upper extremity vibration is not present in this position. Work Environment Access: Restrooms, parking, and breakroom.


DOT No.: 211.462-010 Page 4 Additional Comments: Note: This description represents the requirements of the job based on observations, discussions with the employer representatives, incumbents and others. On occasion, practicality and feasibility prevent the direct observation and/or gathering of objective, quantifiable data. For this reason, a “best estimate” may have been used.


DOT No.: 211.462-010 Page 5 PHYSICIAN: I agree that the above name injured worker can perform the physical activities described in

this job analysis and can return to work. State date worker is released to return to work if different from today’s date .

I agree that the above named injured worker can perform the physical activities described in

this job analysis on a part-time basis for hours per day, days per week. The worker can be expected to progress to full-time, regular duties

in weeks or months . I agree the injured worker can perform the described job but only with modifications

(describe in comments section). Modifications are needed on a permanent or temporary basis.

The above-named injured worker temporarily cannot perform this job based on the

following physical limitations: Anticipated release date: Treatment plan: The above named injured worker is permanently restricted from performing the physical

activities described in this job analysis based on the following physical limitations (state objective medical findings):

Comments: Physician Date



JOB ANALYSIS

Worker: _____________________

Claim No: ___________________ Job Title: Community Site Manager DOT Title: Manager, Apartment House DOT: 186.167-018 GOE: 11.11.01 SVP: 5 Industry: 731 Real Estate Employer: __________________________ C/O Comprehensive Risk Management


Contact Person: Pamela Kaye Dooner Phone Number: 425.252.7623 Analyst: Stacy Lough, CDMS; Janet Snyder, CDMS Date: November 18, 2011 Job Description: Manages Senior Community (over 55 and disabled and/or 61 and older) complex. Community site managers live on-site. (Essential job tasks prioritized below)

1. Shows prospective tenants apartments and explains occupancy terms. 2. Informs prospective tenants of availability of nearby schools, shopping malls, recreational facilities, and public

transportation. 3. Rents or leases apartments, collects security deposit as required, and completes lease form outlining conditions and

terms of occupancy when required. 4. Collects rents due and issues receipts. Issues late notices and follows up on delinquencies. 5. Investigates tenant complaints concerning malfunctions of utilities or furnished household appliances or goods, and

inspects vacated apartments to determine need for repairs or maintenance. 6. Directs and coordinates activities of maintenance staff engaged in repairing plumbing or electrical malfunctions,

painting apartments or buildings, and performing landscaping or gardening work, or arranges for outside personnel to perform repairs. Directs and coordinates the driver and housekeeping.

7. Resolves tenant complaints concerning other tenants or visitors.

Claim No: ____________________

Worker: ______________________ Job Analysis: Community Site Manager

DOT No: 186.167-018 Page 2

Job Qualifications and Skills: High School education and a minimum of four years experience as an Assistant Site Manager, Manager or related field; knowledge of or training in LIHT (Section 42) compliance; knowledge of computers and basic software application including Word, Excel, Internet, Outlook and where appropriate, property management software (e.g. AMSI); ability to work with other employees and address resident concerns in a professional manner; the ability to comprehend and perform all responsibilities of the position; neat, clean and professional appearance; legible handwriting; valid driver’s license and operational vehicle. High School Diploma/GED Required: Yes College Degree: None WA State Driver’s License: Yes Special Endorsements: None Clean Driving Record/Insurable: Yes Basic Computer Skills: Yes Speak/read/write English: Yes Keyboard Speed Required: None Software (name/version): Word, Excel, Outlook Permits/Certifications: None Type of Computer: PC Computer Operating System: Windows XP Licensure: N/A Other:

Type of Machines, Tools, Special Equipment Used: PC Computer, printer, facsimile, copier, standard office supplies. Work Schedule: Full time – 40+/hrs per week

PHYSICAL DEMANDS





Stand: OCASIONALLY when assisting current residents with questions and concerns. Standing occurs on carpet, tile, vinyl and concrete surfaces. Stand and walk are intermittent throughout the shift with static standing limited to under 5 minutes in duration. Walk: OCCASIONALLY when meeting prospective residents and showing the community. Walking occurs on carpet, tile, vinyl and concrete surfaces. Stand and walk are intermittent throughout the shift with walking lasting up to 30 minutes when providing tours to prospective clients or hanging notices/flyers. As needed, may walk throughout the facility to post notices on doors. Sit: FREQUENT to CONSTANT in on-site office when providing management and assistance to residents - documenting concerns, answering questions, collecting rents, preparing marketing materials, etc. Sitting occurs in a swivel office chair. Lift: OCCASIONALLY lift items weighing less than 5 pounds, to include a telephone receiver, folders, papers, a ream of paper. SELDOM lifting up to 20 pounds may be necessary for supplies. Carry: OCCASIONALLY up to 5 pounds for distances of up to 10 feet to obtain office supplies from the supply area (i.e. staples, a ream of paper, etc.). Rubbermaid carts are used to move larger and heavier items/boxes throughout the facility as needed for holiday decorations and supplies.

Claim No: ____________________


DOT No: 186.167-018 Page 3

Push/Pull: OCCASIONALLY with less than 5 pounds of force for normal daily operations of opening/closing a drawers and doors. SELDOM may push cart with supplies requiring up to 10 pounds of push force. Climb: Ladders: Not a required physical demand of the position.

Stairs: Resident buildings have elevators available. Stairs are also available for emergency and for use at employee’s discretion.

Crawl: Not a required physical demand of this position. Bend/Stoop: OCCASIONALLY with a negligible degree of flexion to reach lower shelves and bottom drawer of filing cabinets. This is done from a seated position in an office swivel chair. Crouch/kneel can often be used in lieu of bend/stoop at the worker’s discretion. Crouch/Kneel: See Bend/Stoop. Twist: Not a required physical demand of the position at torso and neck level. The worker can avoid all twisting at these levels by positioning the feet/body relative to the task being performed and utilizing the swivel office chair. Handle/Grasp: Simple grasping techniques requiring less than two pounds of force are used OCCASSIONAL when answering phones, utilizing a computer mouse or supplies. Handling and grasping may occur bilaterally or unilaterally. Fine Manipulation/Fingering: OCCASIONALLY to FREQUENTLY when using phone and keyboard for emails/calls to residents, Corporate Office, public and outreach. Reach: OCCASIONALLY reach from thigh level to shoulder level for supplies around desk area. SELDOM reach below thigh level or above the shoulders when accessing cabinets for supplies. Reaching below thigh level and above shoulder level may be performed unilaterally or bilaterally. Vision/Talk/Hearing: Normal or corrected to normal vision and hearing are required to identify and communicate with residents and work on the computer. Taste/Smell: Required on occasion when verifying cleanliness for ‘move outs’, safety; and evaluating complaints. Environmental Factors/Access: Work is performed inside a climate controlled building. Florescent and natural lighting are utilized. Depending on daily tasks, may be exposed to inclement weather moving between buildings (up to a maximum of 150 feet). Work Environment Access: Parking and restroom facilities are available.


Claim No: ____________________


DOT No: 186.167-018 Page 4

PHYSICIAN:










(253) 661-5550 (206) 203-0057 [fax]


(253) 661-5550 (360) 786-8045 [fax]

JOB ANALYSIS

Worker: Claim No:

Job Title: Cook/Helper DOT: 317.687-010 DOT Title: Cook Helper GOE: 05.12.17 SVP: 2 Location:







Claim No: _____________________ Worker:_____________________ Job Analysis – Cook/Helper

DOT No.: 317.687-010 Page 2 Job Description: (Essential job tasks prioritized below.) Employee is required to engage in preparing foods for institutional setting. Employee may be required to wash, peel, cut and seed vegetables and fruit. Cleans, cuts and grinds meats, poultry and seafood. May be required to weigh and measure designated ingredients for recipe. Prepare salads, deserts and other side dishes. Assists Dietary Cook in preparation of meals. May be required to prepare coffee and hot water. May be required to wash all pots and knives used. May be required to prepare trays for residents. Assist in cleaning of work area at the end of shift. Employee is required to handle food throughout the day. Employee must be able to be on feet all day. Also must be able to keep pace with a busy kitchen to ensure that food is prepared and ready for serving on time. Competencies required to perform the job include: Repetitive or Short Cycle Work: Work situations where performing a few routine and uninvolved tasks over and over again according to set procedures, sequence, or pace with little opportunity for diversion or interruption. Interaction with people is included when it is routine, continual or prescribed. Job Qualifications: Types of Machines, Tools, Special Equipment Used: Meat slicer, food processor, mixer, oven, steamer, spoons, knives, can openers, measuring spoons/cups. Materials, products, subject matter, services: Meals Services, except Domestic Industry Designation: 453, Hotel Restaurant Work Schedule:

PHYSICAL DEMANDS Strength Level: Medium Stand: Standing is performed for three to six hours out of an eight-hour day. Walk: Walking is performed for one to two hours at a time on a hard tiled floor surface. Sit: Sitting is only allowed on breaks and at lunch. Lift: Lifting up to 10 pounds of meats when slicing is occasionally required. May also be required to lift various canned items weighing up to three pounds at a time. Lifting up to 25-pound boxes of vegetables may be occasionally required. Lifting up to 50-pound boxes of kale, lettuce or bags of potatoes may be required occasionally. Lifting over 50 is not be required.


DOT No.: 317.687-010 Page 3 Carry: Frequently required to carry prepared foods weighing up to seven to 10 pounds from preparation area to walk-in refrigerator, a distance of approximately 10 to 15 feet. Carrying boxes of vegetables may be required up to 10 to 20 feet. Up to 50 pound bags of potatoes may need to be carried 10 to 20 feet. Carrying over 50 pounds is not required. Push: Occasionally required when using food cart to move items through kitchen. Pull: See “push”. Controls: Climb: Climbing a ladder is not a requirement of this position. Balance: Balance is needed in relation to standing, walking and sitting while performing this position. Bend/Stoop: Frequent bending may occur while cleaning work area or obtaining items from lower shelves. Crouch: Occasional crouching may occur while cleaning or retrieving food items from lower shelves. Twist: Occasional twisting at waist may occur while preparing food. Kneel: Occasional kneeling may occur while cleaning or retrieving food items from lower shelves. Crawl: Crawling is not a requirement of this position. Handle/Grasp: Constant handling and grasping is required while working and preparing food items. Fine Manipulation/Fingering: Fine finger manipulation is not a requirement of this position. Feeling: Feeling hot and cold is a requirement of this position. Reach: Reaching above shoulder height is occasionally required when reaching for food items on higher shelves. Constant reaching at waist to chest level required when preparing food. Reaching below waist level is occasionally required when cleaning the kitchen area. Vision: Necessary to do the job effectively and correctly. Talk/Hear: Necessary to communicate with others and for taking instructions from others. Taste/Smell: The ability to taste and smell is a requirement of this position.


DOT No.: 317.687-010 Page 4 Environmental Factors: Changes in temperature from stoves and refrigerators. This position is performed indoors 100% of the work shift. Exposure to some cleaning solutions. Whole Body and upper extremity vibration are not present in this position. Work Environment Access: Access to restrooms, breakroom and parking. Additional Comments: Note: This description represents the requirements of the job based on observations, discussions with the employer representatives, incumbents and others. On occasion, practicality and feasibility prevent the direct observation and/or gathering of objective, quantifiable data. For this reason, a “best estimate” may have been used.



(253) 661-5550 (206) 203-0057 [fax]


(253) 661-5550 (360) 786-8045 [fax]

JOB ANALYSIS

Worker: Claim No:

Job Title: Daycare Worker DOT: 359.677-018 DOT Title: Nursery School Attendant GOE: 10.03.03 SVP: 4 Location:

C/O Comprehensive Risk Management ATTN: Pamela K. Dooner 1520 Broadway, Suite 201 Everett, WA 98201






Claim No: ___________________ Worker: ___________________ Job Analysis - Daycare Worker

DOT No.: 359.677-018 Page 2 Job Description: (Essential job tasks prioritized below.) Overall the job requirements are to provide a warm, nurturing, safe and loving environment where self-concepts are enhanced, independence encouraged, and individuality respected. Some of the specific tasks performed include interacting with children, plan weekly lessons, maintain good communications with parents, observe and record behavior, use appropriate discipline, maintain records and files, keep staff informed of program goals and developments, attend meetings and inservices, prepare materials for the programs, report to the supervisor, change and plan activities and room arrangements, and other miscellaneous duties. Competencies required to perform the job include: Variety Of Duties: Work situations that involve frequent changes of tasks using different techniques, procedures, or degrees of attentiveness without loss of efficiency or composure. Dealing with People: Work situations that involve interpersonal relationships in a job setting beyond giving and receiving work instructions. Job Qualifications: Early childhood education is preferred. It is necessary to have CPR, First Aid, and HIV training. Must be 18 years old, have good communication skills, must not have been convicted of child abuse or any crime involving harm to another person. Evidence of emotional maturity and stability. Flexibility to accept changes in staffing patterns. Tolerance of different aspects of parenting and cultural background. Types of Machines, Tools, Special Equipment Used: Toys, cleaning equipment, carts and a multitude of learning supplies. Materials, products, subject matter, services: 942, Daycare Services Industry Designation: 138, Any Industry Work Schedule: The Day Care Center is open between 5:15 A.M. and 6:30 P.M., and hours are scheduled between those time frames.

PHYSICAL DEMANDS Strength Level: Medium

Stand: The majority of the day up to six to seven hours is performed while standing and walking around the Day Care facility at the nursing home site. Walking and standing would be performed on both carpeting and linoleum surfaces anywhere from 15 to 60 minutes at a time, depending on the specific activity. Walk: The majority of the day, up to six to seven hours, job duties are performed while standing and walking around the Day Care facility at the nursing home site. Walking and standing would be performed on both carpeting and linoleum surfaces anywhere from 15 to 60 minutes at a time, depending on the specific activity.


DOT No.: 359.677-018 Page 3 Sit: Sitting would be performed intermittently throughout the day while reading stories to children or assisting with program activities. Sitting may be performed at a standard desk, on the floor, or other seating arrangements. Sitting is usually not performed for any more than two hours per day. Lift: The Day Care worker will frequently lift from 10 to 25 pounds, while working with infants and using supplies and equipment. On occasion, they may lift up to 50 pounds while working with pre-schoolers or moving tables and chairs, and on rare occasions may be required to lift over 50 pounds if a school age child is hurt. Carry: There is frequent carrying of 10 to 25 pounds, and occasional to rare carrying of items up to 50 pounds and over 50 pounds. Maximum distance may be 100 to 200 feet. Push: There is frequent pushing and pulling performed to rearrange furniture, push a lunch cart, performing cleaning activities or other related tasks. Pull: There is frequent pushing and pulling performed to rearrange furniture, push a lunch cart, performing cleaning activities or other related tasks. Controls: No use of foot controls. Driving is not a requirement of this position. May use hand controls on equipment. Climb: There is occasional climbing of stairs performed while performing activities in this position. Climbing ladders is rare. Balance: Working at heights and balancing while using a ladder is rare. Bend/Stoop: There is frequent bending at the waist while working with the children as it is necessary to perform activities at their level. Crouch: Frequent kneeling and squatting are also performed in this position while performing activities with the children. Twist: There is frequent twisting at the waist performed while taking part in developmental activities. Kneel: Frequent kneeling and squatting are also performed in this position while performing activities with the children. Crawl: Crawling would be performed occasionally while taking part in developmental activities. Handle/Grasp: Frequent handle/grasp when engaging in activities. Fine Manipulation/Fingering: Is performed occasionally when doing activities with the children including drawing, cutting, etc.


DOT No.: 359.677-018 Page 4

Feeling: Must be able to detect injuries and emergencies.

Reach: Reaching is performed at all ranges of motion from ground level to overhead on a frequent basis.

Vision: Must be able to observe the work environment and the children in order to ensure their safety.

Talk/Hear: Must have excellent communication skills and be able to interact appropriately with the children, parents and co-workers.

Taste/Smell: Must be able to detect emergencies (i.e. fire).

Environmental Factors: Whole body and upper body vibration is not present. Ordinarily this is a temperature controlled environment. Indoors - 90 % Outdoors - 10 %

Work Environment Access: Access to restrooms.

Additional Comments:

Note: This description represents the requirements of the job based on observations, discussions with the employer representatives, incumbents and others. On occasion, practicality and feasibility prevent the direct observation and/or gathering of objective, quantifiable data. For this reason, a “best estimate” may have been used.



(253) 661-5550 (206) 203-0057 [fax]


(253) 661-5550 (360) 786-8045 [fax]

JOB ANALYSIS

Worker: ______________________ Claim No: ______________________

Job Title: Dietary Cook DOT: 315.361-010 DOT Title: Cook GOE: 05.10.08 SVP: 6 Location: ______________________________________







Claim No: _____________________ Worker: _____________________ Job Analysis - Dietary Cook

DOT No.: 315.361-010 Page 2 Job Description: (Essential job tasks prioritized below.) Prepares and cooks meals for residents and employees of institution. Cooks food in quantities according to the menu and number of persons to be served. Plans menu, taking advantage of foods in season and local availability. May serve meals. May order supplies and keep records and accounts. May direct activities of one or more workers who assist in preparing and serving meals. Prepare various foods depending on menu created by dietitians, for each meal of the day. Operate kitchen equipment in preparation for meals. Required to clean work surfaces following shift: sweep floors, wipe down counter space, cover and store unused foods. Must be able to create meals that are appropriate for the elderly and in large quantities. Employee is required to use institutional size cookware. Must be able to work at a constant pace to ensure the food is ready for each meal of the day. Employee is required to handle food throughout the day. Types of foods: meats, raw vegetables, fresh fruit, canned foods. Competencies required to perform this job include: Variety Of Duties: Work situations that involve frequent changes of tasks using different techniques, procedures, or degrees of attentiveness without loss of efficiency or composure. Making Judgments and Decisions: Work situations that involve solving problems, making evaluations, or reaching conclusions based on subjective or objective criteria, such as the five senses, knowledge, past experiences, or quantifiable or factual data Attaining Precise Set Limits, Tolerances, and Standards: Work situations that involve adhering to and achieving exact levels of performance, using precision measuring instruments, tools, and machines to attain precise dimensions. Preparing exact verbal and numerical records. Complying with precise instruments and specifications for materials, methods, procedures, and techniques to attain specified standards. Job Qualifications: Types of Machines, Tools, Special Equipment Used: Spoons, knives, can openers, measuring spoons/cups, broom, meat slicer, stove, oven, food processor, blender, various pots and pans. Materials, products, subject matter, services: 903, Meals Service Industry Designation: 138, Any Industry Work Schedule:

PHYSICAL DEMANDS Strength Level: Medium Stand: Stand for two to three hours at a time on tile floors, intermittent with walking, up to eight hours per day.


DOT No.: 315.361-010 Page 3 Walk: Walking may be performed from one to two hours at a time intermittent with standing, up to eight hours per day. Sit: Sitting is only performed during breaks and at lunch. Lift: Frequent lifting of up to 10 pounds is required when preparing various food items and using kitchen equipment, i.e. cutting five pound hams on industrial size slicer. Occasional lifting up to 25 pounds when lifting items filled with soup or stew. Lifting up to 50 pounds is rarely required when lifting a 50-pound bag of potatoes - this can be deferred to other workers if the employee is not able to lift this amount. Lifting over 50 pounds is not required Carry: Carrying up to 10 pounds is frequently required when carrying various food items within the kitchen area, usually a distance of five to 20 feet. Carrying up to 25 pounds may be rarely required to carry filled pots from one burner to another. Carrying up to 50 pounds is required on a rare basis when carrying a 50-pound bag of potatoes. Carrying over 50 pounds is not required. Push: Occasionally may be required when pushing and pulling baking sheets to and from the oven with little resistance. Pull: Occasionally may be required when pushing and pulling baking sheets to and from the oven with little resistance. Controls: The use of foot controls is not required in this position. Hand controls such as push buttons, turn knobs, and dials are intermittently used throughout the work shift. Climb: Climbing stairs and ladders is not a requirement of this position. Balance: Balance is needed in relation to standing, walking and sitting while performing this position. Bend/Stoop: Frequent bending at the waist is performed in the course of performing the various job tasks, cleaning lower shelves in kitchen area and while cooking. Crouch: Occasional crouching while cleaning or retrieving items from lower shelves. Twist: Occasional twisting at the waist while cooking. Kneel: Occasional kneeling while cleaning or retrieving items from lower shelves. Crawl: Crawling is not a requirement of this position. Handle/Grasp: Constant handling and grasping is performed in this position while performing such job tasks as food preparation, utensil handling, serving food, etc.


DOT No.: 315.361-010 Page 4 Fine Manipulation/Fingering: Occasionally while preparing food and operating controls. Feeling: May be used to establish the temperature of foods or cooking equipment. Reach: Reaching above shoulder level is occasionally required when reaching for food items in refrigerator or spices on shelves. At shoulder level reaching is frequent while cooking. Reaching below shoulder level is frequent when cleaning kitchen area. Reaching from 1/2 to full arm extension is required. Vision: Necessary for testing quality of food products. Talk/Hear: Necessary for communicating with others and for taking instructions from others. Taste/Smell: Necessary for testing quality of food products. Environmental Factors: Whole body and upper extremity vibration are not present in this position. This position is performed in an indoor environment and is subject to changes due to heat from cooking, etc. Exposure to cleaning solutions include oven cleaner, bleach, etc.. Employees typically are required to wear hairnets. They may also wear rubber gloves when needed while cleaning. Work Environment Access: Access to restroom Additional Comments: Note: This description represents the requirements of the job based on observations, discussions with the employer representatives, incumbents and others. On occasion, practicality and feasibility prevent the direct observation and/or gathering of objective, quantifiable data. For this reason, a “best estimate” may have been used.



(253) 661-5550 (206) 203-0057 [fax]


(253) 661-5550 (360) 786-8045 [fax]

JOB ANALYSIS

Worker: Claim No:

Job Title: Dishwasher DOT: 318.687-010 DOT Title: Kitchen Helper GOE: 05.12.18 SVP: 2 Location: ________________________________







Claim No: ___________________ Worker: ___________________ Job Analysis - Dishwasher

DOT No.: 318.687-010 Page 2 Job Description: (Essential job tasks prioritized below.) Assist in maintaining kitchen work areas and keeping equipment, utensils and food plates clean and orderly. Sweep and mop floors of kitchen and may be required to sweep and mop dining area. May be required to wash food preparation work tables, walls, refrigerators and refrigerated walk-ins. Required to remove garbage from kitchen area and hose out garbage containers. Must be able to operate industrial size dishwasher and able to move quickly in completing tasks at hand. Competencies required to perform this job include: Repetitive or Short Cycle Work: Work situations where performing a few routine and uninvolved tasks over and over again according to set procedures, sequence, or pace with little opportunity for diversion or interruption. Interaction with people is included when it is routine, continual or prescribed. Job Qualifications: Ability to operate industrial dishwater and to perform repetitive work according to set procedures. This job can be learned through on the job training Types of Machines, Tools, Special Equipment Used: Dishwasher, rolling carts, and dish tubs. Materials, products, subject matter, services: 903, Meal Services Industry Designation: 453, Hotel & Restaurant Work Schedule:

PHYSICAL DEMANDS Strength Level: Medium Stand: Standing is performed on a frequent basis while operating dishwasher up to three hours at a time for six hours total on tiled floor surfaces. Walk: Walking frequently, intermittent with standing while performing job tasks. Sit: Sitting is only performed during breaks. Lift: Constant lifting of items weighing from 25 to 30 pounds, consisting of trays of dishes to be loaded and unloaded into the dishwasher. Occasional lifting of up to 20-pound buckets of ice. Carry: The items lifted may be carried a distance of approximately 5-20 feet. Carrying occurs frequently.


DOT No.: 318.687-010 Page 3 Push: Frequent pushing and pulling is performed to push carts of dishes and when pushing the trays into and out of the dishwasher. Pull: See “push” Controls: Intermittently operate dials and controls on equipment while utilizing manual and finger dexterity. No use of foot controls. Climb: Climbing of stairs and ladders is not required. Balance: Balance is needed in relation to standing, walking and sitting while performing this position. Bend/Stoop: Bending is performed on a frequent basis while performing job duties. Crouch: Crouching is not a requirement of this position, although crouching may be performed at the discretion of the worker in place of bending as appropriate. Twist: Twisting is performed on a frequent basis while washing dishes. Kneel: Kneeling is not a requirement of this position. Crawl: Crawling is not a requirement of this position. Handle/Grasp: Repetitive arm and hand motions are used to load and unload the dishwasher and clean food off plates. Fine Manipulation/Fingering: Intermittent operation of dials and controls on the equipment while utilizing manual and finger dexterity. Feeling: Feeling is required in both hands in order to handle and grasp the dishes and determine temperature of the washing water. Reach: Reaching frequently at waist to chest height while operating the dishwasher and performing regular job tasks. Repetitive arm and hand motions are used to load and unload the dishwasher and clean food off plates. Vision: Must be able to navigate around the facility appropriately. Talk/Hear: Must be able to consistently communicate with co-workers and supervisors. Taste/Smell: Not a requirement of this position.


DOT No.: 318.687-010 Page 4 Environmental Factors: Exposure to cleaning solutions and dish washing detergents, food and hot water. Depending on work station, there may be fans utilized. Employee is required to wear a hat or hair net and may implement the use of rubber gloves. Employee also wears a rubber apron to protect from water. The position is performed indoors 100% of the work day. The employee is not exposed to whole body or upper extremity vibration. Work Environment Access: Additional Comments: Note: This description represents the requirements of the job based on observations, discussions with the employer representatives, incumbents and others. On occasion, practicality and feasibility prevent the direct observation and/or gathering of objective, quantifiable data. For this reason, a “best estimate” may have been used.



JOB ANALYSIS

Worker: ________________________

Claim No: ______________________ Job Title: Driver DOT Title: Driver DOT: 913.663-018 GOE: 09.03.01 SVP: 3 Industry: 593 Motor Vehicle Transportation Employer: __________________________ C/O Comprehensive Risk Management


Contact Person: Pamela Kaye Dooner Phone Number: 425.252.7623 Analyst: Stacy Lough, CDMS; Janet Snyder, CDMS Date: November 18, 2011 Job Description: (Essential job tasks prioritized) Drives shuttle van to transport passengers to and from stores, planned lunches, post office, library and other planned outings. Duties and responsibilities include: provide transportation based on monthly events calendar from manager, assist residents in and out of van, assist with securing/storage of wheelchairs/walkers and purchased items, maintain cleanliness of vans, keep vans full of petrol and notify management of vehicle mechanical operation concerns. Job Qualifications and Skills: Be at least 18 years old; experience preferred. Occupational Exploration: To do this kind of work, one must be able to: follow written and oral instructions; read time schedules and meters; follow traffic regulations; think, reason, and act quickly to cope with traffic situations; read maps to locate addresses and select the best routes; memorize routes and passenger pick-up locations; speak clearly to give information to passengers; deal courteously with all kinds of people; judge distances and speeds to avoid accidents; move eyes, hands, and feet together to brake, steer, signal, etc.; read street and traffic signs at a distance; and identify colors of traffic lights. High School Diploma/GED Required: No College Degree: N/A WA State Driver’s License: Yes Special Endorsements: N/A Clean Driving Record/Insurable: Yes Basic Computer Skills: N/A Speak/read/write English: Yes Keyboard Speed Required: N/A Software (name/version): N/A Permits/Certifications: N/A Type of Computer: N/A Computer Operating System (type/version): N/A Licensure: N/A Other: DMV Abstract

Claim No: ____________________

Worker: ______________________ Job Analysis: Driver

DOT No: 913.663-018 Page 2

Type of Machines, Tools, Special Equipment Used: 12 passenger bus and 8 passenger van, cleaning supplies, writing implement and clip board. Work Schedule: Full time

PHYSICAL DEMANDS





Strength: Medium (M), according to the Classification of Jobs (COJ), involves the ability to exert 20 to 50 pounds of force occasionally, 10 to 25 pounds of force frequently, and greater than 10 pounds of force constantly, to move objects.

Stand: OCCASIONALLY stand, alternated with frequent walking and sitting. Walk: OCCASIONALLY walk between parking lot and residence; most often walk on concrete or asphalt. Sit: OCCASIONALLY sit while driving, up to 30 minutes at a time. Lift/Carry: OCCASIONALLY lift/carry items such as pen/pencil, cleaning supplies, groceries, shopping bags, and walkers (can weigh up to 20 pounds). SELDOM lift/carry up to 45 pounds less than 10 feet when storing wheelchairs. Push/Pull: FREQUENTLY push/pull vehicle doors and straps to secure wheelchairs in place. SELDOM use 25 pounds force to push/pull wheelchairs into place in the van or to assist residents in/out of the van. Controls: FREQUENTLY use hand and foot controls on vehicles. SELDOM (3 times per week) use hydraulic wheelchair lift and lever to fold van chairs. Climb: OCCASIONALLY climb three steps in and out of vans. Balance: Within normal limits. Bend/Stoop: OCCASIONALLY bend/stoop assisting residents to enter/exit van and to store items in cargo space. Crouch: Worker will crouch when accessing folding mechanisim for van chair 3 times per week. Worker may choose to crouch in lieu of stooping. Twist: OCCASIONAL twisting at the neck while driving vehicle. Kneel/Crawl: May be required when accessing folding mechanisim for van chair roughly 3 times per week.

Claim No: ____________________


DOT No: 913.663-018 Page 3

Handle/Grasp: CONSTANT handle/grasp steering wheel, pen/pencil, wheelchairs, walkers, shopping bags and additional supplies. Fine Manipulation/Fingering: SELDOM when operating wheelchairs and van and when writing. Feeling: Within normal limits. Reach: FREQUENT reaching between waist and chest level performed while driving, storing purchases and assisting residents . OCCASIONAL reaching above chest level or below waist level. Vision: Normal vision or corrected to normal necessary to drive vehicles. Talk/Hear: Necessary to communicate with residents and when operating vehicle. Taste/Smell: Within normal limits. Environmental Factors: FREQUENTLY exposed to all weather conditions, especially when walking to and from parking lot. Work Environment Access: Adequate access to parking, break areas and restrooms. Additional Comments:


Claim No: ____________________


DOT No: 913.663-018 Page 4

PHYSICIAN:










(253) 661-5550 (206) 203-0057 [fax]


(253) 661-5550 (360) 786-8045 [fax]

JOB ANALYSIS

Worker: Claim No:

Job Title: Feeder/Bedmaker DOT: 355.674-014 DOT Title: Nurse Assistant GOE: 10.03.02 SVP: 4 Location: _______________________________


Contact Person: Pamela Kaye Dooner Phone Number: 425-252-7623 Analyst: Janet Snyder Date: 9/13/06





Claim No: _________________ Worker: _________________ Job Analysis - Feeder/Bedmaker

DOT No.: 355.674-014 Page 2 Job Description: (Essential job tasks prioritized below.) This is a position that requires the employee to provide additional assistance to housekeeping and nursing staff. The employee assists in changing residents’ bed linens and feeding the residents their meals in the dining area. Various job tasks include: filling the utility cart with clean linens to take to the individual residents rooms, changing linens on residents beds (Remove soiled linens and replace with clean ones), assist in passing out fresh water to residents and picking up the used water pitchers. May be required to turn mattresses, checking for any tears in the mattress. Assist residents to the dining room. Pass food trays to individual residents in accordance with the diet card on the tray. Document the intake of the residents on a specified card. Assist in the feeding of residents that require this help. Stock the utility rooms with clean linens from the laundry area. May be required to clean residents’ combs and brushes. Competencies required to perform the job include: Variety Of Duties: Work situations that involve frequent changes of tasks using different techniques, procedures, or degrees of attentiveness without loss of efficiency or composure. Dealing with People: Work situations that involve interpersonal relationships in a job setting beyond giving and receiving work instructions. Performing Under Stress: Work situations that involve coping with circumstances dangerous to the worker or others. Job Qualifications: Types of Machines, Tools, Special Equipment Used: Linen cart and supply cart. Materials, products, subject matter, services: 923, Medical Assistant, Aide, Attendant Services Industry Designation: 573, Medical Services Work Schedule:


DOT No.: 355.674-014 Page 3 PHYSICAL DEMANDS Strength Level: Heavy Stand: Standing may be performed for two to three hours at a time, interspersed with walking, on a carpeted, tile, or linoleum floor. Walk: Walking is performed on a constant basis for up to three hours at a time on carpeting, linoleum and tile floors. Sit: Sitting is performed only for one hour total, per work-day, while on breaks and lunch. Lift: Frequent lifting up to 10 pounds (i.e. stacks of linens). Occasionally lifting 10 to 25 pounds while making beds. Occasionally lifting 25-50 pounds to flip mattresses on a weekly basis. Occasionally lifting over 50 pounds, up to 100 pounds, to assist in transfer of a resident from a bed to a wheelchair. Carry: Frequently carrying up to 10 pounds of bed linens from a cart into residents’ rooms, up to 10 feet. Carrying over 10 pounds is not required for this position. Push: Occasional pushing is required when wheeling the laundry cart from the utility area to the residents’ rooms. The utility cart rolls easily across carpeting or tile floors. Pull: Occasionally required when wheeling the laundry cart from the utility area to the residents’ rooms. The utility cart rolls easily across carpeting or tile floors Controls: Not a requirement of this occupation. Climb: Climbing of stairs and ladders is not a requirement of this position. Balance: Balance is needed in relation to standing, walking and sitting while performing this position. Bend/Stoop: Occasional bending may occur while assisting resident from bed to wheelchair or while assisting in feeding of residents. Crouch: Occasionally, at the discretion of the worker, while changing bed linen. Twist: Occasional twisting at the waist while changing bed linens. Kneel: Occasionally, at the discretion of the worker, while changing bed linen. Crawl: Crawling is not a requirement of this position. Handle/Grasp: Frequent handling and grasping of bed linens, eating utensils, etc.


DOT No.: 355.674-014 Page 4 Fine Manipulation/Fingering: Intermittently performed while assisting with residents with feeding. Feeling: Within normal limits for secure grasp. Reach: Occasional reaching above shoulder level when restocking utility room with clean linens from laundry area. Frequent reaching at and below shoulder level while making beds. Vision: Necessary for doing the job effectively and correctly. Talk/Hear: Necessary for communicating with others and for taking instruction from others. Taste/Smell: Within normal limits. Environmental Factors: Exposure to infectious diseases. May be required to wear a uniform as directed by the facility. Work Environment Access: Facility is wheelchair accessible. Additional Comments: Note: This description represents the requirements of the job based on observations, discussions with the employer representatives, incumbents and others. On occasion, practicality and feasibility prevent the direct observation and/or gathering of objective, quantifiable data. For this reason, a “best estimate” may have been used.



(253) 661-5550 (206) 203-0057 [fax]


(253) 661-5550 (360) 786-8045 [fax]

JOB ANALYSIS

Worker: Claim No:

Job Title: Homemaker DOT: 309.674-014 DOT Title: Personal Attendant GOE: 09.05.06 SVP: 3 Location:

C/O Comprehensive Risk Management ATTN: Pamela Kaye Dooner 1520 Broadway, Suite 201 Everett, WA



frequency of an activity as a percentage of the workday. These categories are defined as follows:



Claim No: ____________________ Worker: ____________________ Job Analysis - Homemaker

DOT No.: 309.674-014 Page 2 Job Description: (Essential job tasks prioritized below.) The worker is responsible for the delivery of care to the residents living in the independent living dwellings. Responsible for some housecleaning; i.e., dusting, mopping, vacuuming, laundry, etc. May be required to grocery shop for residents. May be required to prepare meals for residents. May be required to assist in bathing and dressing of residents. Responsible for notifying the nursing staff of the condition of the residents if the condition has changed and the need for further medical care is warranted. Competencies required to perform the job include: Variety Of Duties: Work situations that involve frequent changes of tasks using different techniques, procedures, or degrees of attentiveness without loss of efficiency or composure. Dealing with People: Work situations that involve interpersonal relationships in a job setting beyond giving and receiving work instructions. Job Qualifications: Employee must be able to communicate effectively, verbally and in writing. Must be able to work well with others and especially the elderly. Must be able to problem-solve and work well alone. Valid Washington State Drivers License, personal vehicle, and auto insurance. Types of Machines, Tools, Special Equipment Used: May be required to operate an automobile and cleaning equipment. Materials, products, subject matter, services: 906, Apparel and Furnishings Services Industry Designation: 319, Domestic Services Work Schedule:

PHYSICAL DEMANDS Strength Level: Medium Stand: Frequent standing on varying floor surfaces including carpet, linoleum, tile and concrete, for up to three hours a day. Walk: Frequent walking, for up to three hours during the workday, on surfaces of carpet, linoleum, tile and concrete. Sit: Occasionally sitting, for one hour at a time, up to two hours per day. Lift: Frequent lifting up to 10 pounds is required when performing various housecleaning duties; i.e., vacuuming, emptying garbage containers, etc. Occasional lifting of up to 25 pounds occurs when lifting groceries if resident requires this service. Lifting up to and over 50 pounds is rarely required to assist resident in bathing which may result in bearing weight of resident with some assistance.


DOT No.: 309.674-014 Page 3 Carry: Frequently carrying up to 10 pounds is required when performing various housecleaning duties; i.e., vacuuming, emptying garbage containers, etc. Carrying up to 25 pounds may occasionally be required when grocery shopping for resident. Carrying over 25 pounds is not required. Push: Occasional pushing while vacuuming residence. Pull: Occasionally pulling while vacuuming residence. Controls: Use of foot controls and hand controls are required when driving a vehicle to perform shopping for residents. Climb: Occasionally may climb stairs, up to two to three flights. Elevators are typically available. Climbing ladders is not required. Balance: Balance is needed in relation to standing, walking and sitting while performing this position. Bend/Stoop: Frequent bending at the waist occurs while dusting and cleaning. Crouch: Rare crouching/squatting occurs while dusting and cleaning lower furniture. Twist: Occasional twisting at the waist may occur while performing cleaning duties or doing laundry. Kneel: Rare kneeling when dusting and cleaning lower furniture. Crawl: Rare crawling when dusting under beds. Handle/Grasp: Constant handling of objects of varying sizes and weights such as canned foods, cleaning supplies, etc. Frequent to constant grasping is used during the course of the day to grasp cleaning supplies and other items. Fine Manipulation/Fingering: Fine finger manipulation is not a requirement of this position. Feeling: Necessary to grasp controls, cleaning equipment, etc. and to feel hot and cold while cooking for the resident. Reach: Occasional reaching above shoulder height may occur when housecleaning or placing food items on shelves for resident after shopping. Frequently reaching at shoulder height when housecleaning. Frequently reaching below shoulder height when housecleaning. Vision: Necessary for doing the job effectively and correctly. Talk/Hear: Necessary for communicating and taking instructions from others.


DOT No.: 309.674-014 Page 4 Taste/Smell: May be used when cooking for the resident or smelling chemicals/smoke. Environmental Factors: Exposure to cleaning solutions, dust and some infectious diseases. May be required to use rubber gloves while using cleaning solutions. 90% of the job tasks are performed indoors/climate controlled. Whole body and upper extremity vibration Work Environment Access: Additional Comments: Note: This description represents the requirements of the job based on observations, discussions with the employer representatives, incumbents and others. On occasion, practicality and feasibility prevent the direct observation and/or gathering of objective, quantifiable data. For this reason, a “best estimate” may have been used.



JOB ANALYSIS

Worker: ______________________

Claim No: ____________________ Job Title: Housekeeper – Assisted Living DOT Title: Cleaner, Housekeeping DOT: 323.687-014 GOE: 05.12.18 SVP: 2 Industry: 138 Any Industry Employer: __________________________________ C/O Comprehensive Risk Management


Contact Person: Pamela Kaye Dooner Phone Number: 425.252.7623 Analyst: Stacy Lough, CDMS; Janet Snyder, CDMS Date: November 17, 2011 Job Description: Provide cleaning service to maintain clean rooms and common areas for assisted living residents. Worker will clean five residential units per day. Linens are changed by the Resident Service Associates (RSA) not Housekeeping. (Essential job tasks prioritized below)

a. Pick up trash from kitchen, dining room, public restroom and laundry. b. Mop public restroom, laundry and kitchen. c. Clean public restroom and check toilet paper, soap, toilet seat cover and paper towel. d. Use broom and dust pan to clean carpet in dining room. e. Vacuum rooms. f. Assist with extra projects as assigned.

Job Qualifications and Skills: The ability to follow verbal instruction and perform routine work. Ability to read English for cleaning/chemical labels (writing not necessary). High School Diploma/GED Required: No College Degree: N/A WA State Driver’s License: No Special Endorsements: N/A Clean Driving Record/Insurable: N/A Basic Computer Skills: N/A Speak/read/write English: Basic ability needed Keyboard Speed Required: N/A Software (name/version): N/A Permits/Certifications: N/A Type of Computer: N/A Computer Operating System (type/version): N/A Licensure: N/A Other:

Claim No: ____________________

Worker: ______________________ Job Analysis: Housekeeper - Assisted Living

DOT No: 323.687-014 Page 2

Type of Machines, Tools, Special Equipment Used: Vacuum, housekeeping cart, cleaning rags, mop bucket, cleaning supplies, gloves and respiratory mask for viral sanitizing. Work Schedule: Full time.

PHYSICAL DEMANDS





Strength: Light (L), according to the Classification of Jobs (COJ), involving the ability to lift/carry up to 20 pounds maximum and up to 10 pounds on a frequent basis.

Stand: FREQUENT while performing daily job tasks up to two hours at a time, up to eight hours total per day, interspersed with walking between rooms. Standing occurs on carpeted, wood and vinyl floors. Stand and walk combined are CONSTANT. Walk: FREQUENT walking between rooms performed intermittently with static standing throughout the work shift. Maximum distance walked at one time is 50 feet between rooms and residential units. Walking occurs on carpeted, wood, concrete and vinyl floors. Walk and stand combined are CONSTANT. Sit: SELDOM sit. Lift: Floor to Waist Level: CONSTANT lift ounces for cleaning supplies; FREQUENTLY lift up to 5 pounds of dirty

clothes and garbage; SELDOM, 4 x 6 times day lift up to 20 pounds for mop bucket of water and vacuum. Waist to Shoulder Level: CONSTANT lift of ounces for cleaning supplies; FREQUENT lift up to 5 pounds for clean linens.

Shoulder Level to Overhead: SELDOM lift ounces of cleaning rags and supplies. Carry: FREQUENTLY carry 0-2 pounds up to a distance of 50 feet. FREQUENTLY carry 2-5 pounds up to 15 feet. Push/Pull: FREQUENTLY push/pull vacuum, mop and broom. OCCASIONALLY push/pull housekeeping cart requiring 15 pounds force. Controls: OCCASIONALLY operate finger and foot controls to turn the vacuum on/off. Climb: Stair and ladder climbing are not a requirement of this position. Step stools are available. Balance: Not a required physical demand of this position. Bend/Stoop: OCCASIONAL bending at the waist while performing cleaning activities, special projects (i.e. wiping down patio furniture, removing chair marks on walls). Crouch/kneel/bend/stoop may be used interchangeably at employee’s discretion and combined total a FREQUENT demand.

Claim No: ____________________


DOT No: 323.687-014 Page 3

Crouch: OCCASIONAL to pick items up off the floor, to clean tub/showers. Crouch/kneel/bend/stoop may be used interchangeably at employee’s discretion. Kneel: OCCASIONAL at employee’s discretion when cleaning tub/showers. Crouch/kneel/bend/stoop may be used interchangeably at employee’s discretion. Crawl: Not a physical demand of this position. Twist: OCCASIONAL twist at the waist while wiping down beds, cleaning tight bathroom spaces and walls, vacuuming, mopping and changing linens. Handle/Grasp: CONSTANT light force when handling linens, cleaning materials and mop. Forceful grasping is needed OCCASIONALLY when vacuuming and moving housekeeping cart (see push/pull). Fine Manipulation/Fingering: SELDOM when operating controls on the vacuum and when calling custodian or other staff. Feeling: As needed to check water temperatures for cleaning. Reach: Floor to knee level: SELDOM for cleaning walls (if a room requires deeper cleaning for infection

decontamination), cleaning bathroom spaces and cleaning bed frames. Knee to chest level: FREQUENT for majority of daily cleaning requirements – mopping, vacuuming, cleaning mirrors and windows, sinks, tables and emptying garbage. Chest level to overhead: SELDOM for cleaning walls, kitchen cupboards, windows and dusting.

Vision: CONSTANT to verify cleanliness and navigate facility. Normal or corrected to normal vision required. Talk/Hear: Must be able to communicate with supervisors, co-works and residents. Taste/Smell: Taste not a requirement of this position. Ability to discriminate smells for sanitary conditions. Environmental Factors: Exposure to cleaning solutions, dust and some infectious diseases. Exposure to upper extremity vibration when vacuuming. Work Environment Access: Access to parking, restrooms and break area. Note: This description represents the requirements of the job based on personal observations, discussions with the employer representatives, incumbents and other professional resources. On occasion, practicality and feasibility prevent the direct observation and/or gathering of objective, quantifiable data. For this reason, a “best estimate” may have been used.

Claim No: ____________________


DOT No: 323.687-014 Page 4

PHYSICIAN:










JOB ANALYSIS

Worker: _______________________

Claim No: _____________________ Job Title: Housekeeper – Nursing Home DOT Title: Cleaner, Housekeeping DOT: 323.687-014 GOE: 05.12.18 SVP: 2 Industry: 138 Any Industry Employer: __________________________________ C/O Comprehensive Risk Management


Contact Person: Pamela Kaye Dooner Phone Number: 425.252.7623 Analyst: Stacy Lough, CDMS; Janet Snyder, CDMS Date: November 17, 2011 Job Description: Provide cleaning service to maintain clean rooms and common areas in nursing home. Worker will clean up to 30 rooms per day. (Essential job tasks prioritized below)

a. Pick up trash, remove garbage from room. b. Remove bed linens and place in laundry chute; replace with new clean linens. c. Mop and clean bathroom mirrors, sink, toilet, shower and floors. d. Vacuum resident room and entry way (janitor vacuums halls). e. Clean inside windows as needed. f. Provide wall washing and deep cleaning for viral infection decontamination. g. Wipe down hydraulic bed frames as assigned. h. Assist with extra projects as assigned.

Job Qualifications and Skills: The ability to follow verbal instruction and perform routine work. Ability to read English for cleaning/chemical labels (writing not necessary). High School Diploma/GED Required: No College Degree: N/A WA State Driver’s License: No Special Endorsements: N/A Clean Driving Record/Insurable: N/A Basic Computer Skills: N/A Speak/read/write English: Basic ability needed Keyboard Speed Required: N/A Software (name/version): N/A Permits/Certifications: N/A Type of Computer: N/A Computer Operating System (type/version): N/A Licensure: N/A Other:

Claim No: ____________________

Worker: ______________________ Job Analysis: Housekeeper - Nursing Home

DOT No: 323.687-014 Page 2

Type of Machines, Tools, Special Equipment Used: Vacuum, housekeeping cart, linens, mop bucket, cleaning supplies, gloves, respiratory mask for viral sanitizing. Work Schedule: Full time.

PHYSICAL DEMANDS





Strength: Light (L), according to the Classification of Jobs (COJ), involving the ability to lift/carry up to 20 pounds maximum and up to 10 pounds on a frequent basis.

Stand: FREQUENT while performing daily job tasks up to two hours at a time, up to eight hours total per day, interspersed with walking between rooms. Standing occurs on carpeted, wood and vinyl floors. Stand and walk combined are CONSTANT. Walk: FREQUENT walking between rooms performed intermittently with static standing throughout the work shift. Maximum distance walked at one time is 200-300 feet between rooms, elevator and storage closet. Walking occurs on carpeted, wood and vinyl floors. Walk and stand combined are CONSTANT. Sit: SELDOM sit. Lift: Floor to Waist Level: CONSTANT lift ounces for cleaning supplies; FREQUENTLY lift up to 5 pounds of dirty

clothes and garbage; SELDOM, 4 x 6 times day lift up to 20 pounds for mop bucket of water and vacuum. Waist to Shoulder Level: CONSTANT lift of ounces for cleaning supplies; FREQUENT lift up to 5 pounds for clean linens.

Shoulder Level to Overhead: SELDOM lift ounces of cleaning rags and supplies. Carry: FREQUENTLY carry 0-2 pounds up to a distance of 50 feet. FREQUENTLY carry 2-5 pounds up to 15 feet. Push/Pull: FREQUENTLY push/pull vacuum, mop and broom. OCCASIONALLY push/pull housekeeping cart requiring 15 pounds force. SELDOM move bed frames with caster wheels requiring 35 pounds force. Controls: OCCASIONALLY operate finger and foot controls to turn the vacuum on/off. Climb: Elevators are available. Stair and ladder climbing are not a requirement of this position. Step stools are available. Balance: Not a required physical demand of this position. Bend/Stoop: OCCASIONAL bending at the waist while performing cleaning activities, special projects (i.e. wiping down patio furniture, removing chair marks on walls). Crouch/kneel/bend/stoop may be used interchangeably at employee’s discretion and combined total a FREQUENT demand.

Claim No: ____________________


DOT No: 323.687-014 Page 3

Crouch: OCCASIONAL to pick items up off the floor, to clean tub/showers. Crouch/kneel/bend/stoop may be used interchangeably at employee’s discretion. Kneel: OCCASIONAL at employee’s discretion when cleaning tub/showers. Crouch/kneel/bend/stoop may be used interchangeably at employee’s discretion. Crawl: SELDOM crawl. Two rooms each day are chosen for deeper disinfecting and may require crawling to clean under bed frame. Twist: OCCASIONAL twist at the waist while wiping down beds, cleaning tight bathroom spaces and walls, vacuuming, mopping and changing linens. Handle/Grasp: CONSTANT light force when handling linens, cleaning materials and mop. Forceful grasping is needed OCCASIONALLY when vacuuming and moving housekeeping cart (see push/pull). Fine Manipulation/Fingering: SELDOM when operating controls on the vacuum and when calling custodian or other staff. Feeling: As needed to check water temperatures for cleaning. Reach: Floor to knee level: SELDOM for cleaning walls (if a room requires deeper cleaning for infection

decontamination), cleaning bathroom spaces and cleaning bed frames. Knee to chest level: FREQUENT for majority of daily cleaning requirements – mopping, vacuuming, cleaning mirrors and windows, sinks, tables and emptying garbage. Chest level to overhead: SELDOM for cleaning walls and windows and dusting.

Vision: CONSTANT to verify cleanliness and navigate facility. Normal or corrected to normal vision required. Talk/Hear: Must be able to communicate with supervisors, co-works and residents. Taste/Smell: Taste not a requirement of this position. Ability to discriminate smells for sanitary conditions of unit. Environmental Factors: Exposure to cleaning solutions, dust and some infectious diseases. Exposure to upper extremity vibration when vacuuming. Work Environment Access: Access to parking, restrooms and break area. Additional Comments:


Claim No: ____________________


DOT No: 323.687-014 Page 4

PHYSICIAN:










JOB ANALYSIS

Worker: ______________________

Claim No: ____________________

Job Title: Housekeeper DOT Title: Cleaner, Housekeeping DOT: 323.687-014 GOE: 05.12.18 SVP: 2 Industry: 138 Any Industry Employer: __________________________ C/O Comprehensive Risk Management


Contact Person: Pamela Kaye Dooner Phone Number: 425.252.7623 Analyst: Stacy Lough, CDMS; Janet Snyder, CDMS Date: November 18, 2011 Job Description: (Essential job tasks prioritized below) Assist in maintaining and cleaning common areas in a senior retirement apartment community. Tasks include:

Disinfect and clean community bathrooms in each building (sink, toilet, floors, mirrors). Vacuum, sweep and/or mop all halls, community room, sun rooms, kitchens and lobby. Dust and clean library, community areas, window sills, windows and stair wells.

Job Qualifications and Skills: The ability to follow verbal instructions and perform routine work. Must be able to speak conversational English. Experience preferred. Must pass background check. (Pre-employment drug screen and high school diploma not required). High School Diploma/GED Required: No College Degree: N/A WA State Driver’s License: No Special Endorsements: N/A Clean Driving Record/Insurable: N/A Basic Computer Skills: N/A Speak/read/write English: Basic communication required

Keyboard Speed Required: N/A

Software (name/version): N/A Permits/Certifications: N/A Type of Computer: N/A Computer Operating System (type/version): N/A Licensure: N/A Other:

Claim No: ____________________

Worker: ______________________ Job Analysis: Housekeeper

DOT No: 323.687-014 Page 2

Type of Machines, Tools, Special Equipment Used: Vacuum, housekeeping cart, mop and bucket, cleaning supplies and Motorola walkie/talkies. Work Schedule: Full time.

PHYSICAL DEMANDS





Strength Level: Light (L), according to the Classification of Jobs (COJ), involving the ability to lift/carry up to 20 pounds maximum and up to 10 pounds on a frequent basis. Stand: Standing occurs intermittently with walking so together these two demands occur on a CONSTANT basis. Standing tends to be dynamic, occurring in conjunction with movement in such a way as to involve frequent changes of position. Standing occurs over level surfaces within the establishment. Stand/walk on carpeted/linoleum/concrete floors. Walk: Walking occurs intermittently with standing so together these two demands occur on a CONSTANT basis. Walking occurs over level surfaces within the establishment. Stand/walk on carpeted/linoleum/concrete floors. Sit: Not a required physical demand of the position. Lift: FREQUENTLY up to 10 pounds for mops, supplies and garbage. OCCASIONALLY lift from 11 to 20 pounds. The heaviest item lifted is the vacuum cleaner with attachments (approximately 20 pounds) and it is lifted 8” off the floor to the cleaning cart. Carry: OCCASIONALLY from 1 to 20 pounds when moving full mop bucket. Carrying occurs for distances of up to 20 feet between supply closets and the cart or to/from a room to the cart. Push/Pull: FREQUENTLY with variable force when cleaning, using the vacuum, moving patio furniture or moving the rolling cart. Push/pull force required for the cart is approximately 10 pounds and the maximum required of all job tasks. Controls: OCCASIONALLY operate finger and foot controls to turn the vacuum on/off. Climb: Not a required physical demand of the position. Elevators are available. Ladder climbing is not required. Balance: Within normal limits. Bend/Stoop: FREQUENT bend/stoop at waist and/or neck level while performing job tasks throughout shift. Crouch/kneel may often be used in lieu of bending or stooping at the waist. Crouch: See “Bend/Stoop.”

Claim No: ____________________


DOT No: 323.687-014 Page 3

Twist: OCCASIONAL to FREQUENT twist at waist when vacuuming, moping and cleaning. Kneel: See Bend/Stoop. SELDOM as needed to reach tight spaces for cleaning or dropped items. Crawl: Not a required physical demand of the position. Handle/Grasp: FREQUENT to CONSTANT use of power and simple grasping/handling throughout the shift to use dust rags and cleaning solution bottles, to move carts and to perform other daily tasks. Fine Manipulation/Fingering: OCCASIONALLY to squeeze trigger on spray bottles, operate vacuum cleaner and elevator buttons, etc. Feeling: Within normal limits. Reach: FREQUENT reach at up to full-extension from knee to chest levels to clean mirrors and widows, vacuum, mop and perform general cleaning. OCCASIONALLY reach overhead for dusting. Vision: Within normal limited or corrected to normal. Talk/Hear: OCCASIONAL to FREQUENT - must be able to communicate with supervisor, co-workers and residents. Taste/Smell: Within normal limits. Smell for cleanliness. Environmental Factors: Exposure to household cleaning solutions and dust. Work is performed within climate controlled buildings. Worker may be exposed to weather when moving between buildings. The worker is exposed to mild vibration when operating the vacuum. Work Environment Access: Parking, break area, and restrooms are available. Note: This description represents the requirements of the job based on observations, discussions with the employer representatives, incumbents and other professional resources. On occasion, practicality and feasibility prevent the direct observation and/or gathering of objective, quantifiable data. For this reason, a “best estimate” may have been used.

Claim No: ____________________


DOT No: 323.687-014 Page 4

PHYSICIAN:










(253) 661-5550 (206) 203-0057 [fax]


(253) 661-5550 (360) 786-8045 [fax]

JOB ANALYSIS

Worker: Claim No:

Job Title: Kitchen Aid DOT: 318.687-010 DOT Title: Kitchen Helper GOE: 05.12.18 SVP: 2 Location:







Claim No: ___________________ Worker: ___________________ Job Analysis - Kitchen Aid

DOT No.: 318.687-010 Page 2 Job Description: (Essential job tasks prioritized below.) Provides assistance in the kitchen area prior to, during and after meals are served to the residents. Also, may be required to provide assistance to the nursing staff by passing water to all residents within the facility. May assist dishwasher following meal in scraping plates. May assist in passing water pitchers to residents and later retrieving pitchers. May assist prep cook in preparing deserts or snacks for residents. May set up meal trays for residents according to special diets and personal requests. May be required to note the amount of food consumed by the residents during the meal. May be required to carry trays to residents who are ill. May be required to clean tables in the dining area after each meal. This position is primarily used to assist the kitchen and nursing staff in providing assistance wherever needed. Must be able to tolerate the fast pace of a busy kitchen. Competencies required to perform the job include: Repetitive or Short Cycle Work - Work situations where performing a few routine and uninvolved tasks over and over again according to set procedures, sequence, or pace with little opportunity for diversion or interruption. Interaction with people is included when it is routine, continual or prescribed. Job Qualifications: Job duties can be learned through short term on the job training. Ability to interact with residents. Types of Machines, Tools, Special Equipment Used: Water pitcher, cooking/preparation utensils, trays, glasses, plates, etc. Materials, products, subject matter, services: 903, Meal Services Industry Designation: 453, Hotel and Restaurant Work Schedule:

PHYSICAL DEMANDS Strength Level: Medium Stand: Frequent standing and walking up to two hours at a time, up to eight hours total on surfaces varying from carpeting, linoleum and tile. Some floor surfaces may be wet when dish washing or from food dropped on the floor. Walk: Frequent walking and standing up to two hours at a time, up to eight total on surfaces varying from carpeting, linoleum and tile. Some floor surfaces may be wet when dish washing or from food dropped on the floor. Sit: Sitting only during breaks and lunch. Lift: Frequent lifting up to 10 pounds when assisting dishwasher and emptying trays. Pull trays from tray rack which may contain plates, utensils and glassware. This may weigh from 10 to 12


DOT No.: 318.687-010 Page 3 pounds. Occasional lifting 10 to 25 pounds (a stack of clean trays). Lifting from 25 to 50 pounds may be required when passing filled water pitchers to residents from a tray. Lifting over 50 pounds is not required. Carry: Frequent carrying of food trays to ill residents in their room. Trays may weigh 10 to 12 pounds. Occasionally carry a stack of clean trays to a holding area weighing from 10 to 25 pounds a distance of approximately 10 to 20 feet at one time. Not required to carry anything over 25 pounds. Push: Occasional pushing during the course of a day when passing water pitchers and when pushing a cart holding the water pitchers. Cart rolls easily across tile surface. Pull: See “push” Controls: Use of hand controls may be required to operate kitchen equipment. Climb: Not required. Balance: Balance is needed in relation to standing, walking and sitting while performing this position. Bend/Stoop: Frequent bending at the waist occurs while dish washing. Crouch: Seldom crouching may occur. Twist: Occasional twisting at waist when assisting dishwasher or passing water pitchers to residents. Kneel: Seldom kneeling may occur. Crawl: Not required. Handle/Grasp: Frequent grasping when passing water pitchers, grasping food trays and assisting the prep cook. Constant handling of various items such as food, plastic water pitchers, plastic food trays, utensils and various sizes of glassware. Occasional repetitive arm and hand motion when scraping plates and loading trays for the dishwasher. Fine Manipulation/Fingering: Not required. Feeling: The ability to feel the difference between hot and cold water. Reach: Occasional reaching above the shoulder level. Frequent reaching between shoulder height and waist when passing water pitchers and when cleaning tables in dining area after each meal. Occasoinal reaching below waist when assisting the dishwasher. Occasional repetitive arm and hand motion when scraping plates and loading trays for the dishwasher. Vision: Necessary for doing the job effectively and correctly.


DOT No.: 318.687-010 Page 4 Talk/Hear: Necessary for communicating with others and for taking instructions from others. Taste/Smell: Within normal limits. Environmental Factors: Occasionally may be exposed to cleaning solutions; i.e., bleach and water. May implement the use of rubber gloves while using cleaning solutions. Also may be required to wear a hair net. 100% of the job is performed indoors. There is no upper body or whole body vibration in this position. Work Environment Access: Access to restroom, parking, and breakroom. Additional Comments: Note: This description represents the requirements of the job based on observations, discussions with the employer representatives, incumbents and others. On occasion, practicality and feasibility prevent the direct observation and/or gathering of objective, quantifiable data. For this reason, a “best estimate” may have been used.



JOB ANALYSIS

Worker: _______________________

Claim No: _____________________

Job Title: Laundry Worker – Nursing Home DOT Title: Laundry Worker II DOT: 361.685-018 GOE: 06.04.35 SVP: 2 Industry: 138 Any Industry Employer: __________________________________ C/O Comprehensive Risk Management


Contact Person: Pamela Kaye Dooner Phone Number: 425.252.7623 Analyst: Stacy Lough, CDMS; Janet Snyder, CDMS Date: November 17, 2011 Job Description: Worker maintains supply of clean linens, towels and clothes for use by residents and/or staff. (Essential job tasks prioritized below)

a. Retrieve laundry from laundry chutes using carts approximately 30”x67”x42” (1 cubic yard capacity). b. Sort laundry into groups: sheets and gowns, blankets, bath blankets and soiled items. Each resident’s personal

laundry arrives separately, is weighed and charged by the pound. c. Load articles into commercial front load washers (opening approximately 32” off floor) and add specified amount

of detergent. (average of 30-40 loads of laundry each day). d. Pull wet articles from washer to cart measuring with false bottom at 24” off floor. e. Place wet articles into commercial front load dryers (opening center approximately 33” off floor). f. Remove articles from dryer into cart and fold on counter at 36” height. g. Place clean folded articles on portable wire storage racks with shelves at 12”, 30”, 48” and 60” off floor or in

appropriate storage bin. h. May return storage racks to utility closets on resident floors for housekeeping and staff use. i. May hang clothes on racks according to name and numbers. May deliver all personal laundry to designated areas. j. May ensure that all clothes are mended and ready to wear. k. Specific jobs as assigned by supervisor.

Claim No: ____________________

Worker: ______________________ Job Analysis: Laundry Worker – Nursing Home

DOT No: 361.685-018 Page 2

Job Qualifications and Skills: One year of experience in a commercial establishment. Ability to meet the physical demands of the position. High School Diploma/GED Required: No College Degree: N/A WA State Driver’s License: No Special Endorsements: N/A Clean Driving Record/Insurable: N/A Basic Computer Skills: N/A Speak/read/write English: Basic English ability Keyboard Speed Required: N/A Software (name/version): N/A Permits/Certifications: N/A Type of Computer: N/A Computer Operating System (type/version): Licensure: N/A Other:

Type of Machines, Tools, Special Equipment Used: Industrial front load washers and dryers, scale, wire racks, carts, various rolling baskets and bins and hangers. Work Schedule: Full time.

PHYSICAL DEMANDS





Strength: Medium (M), according to the Classification of Jobs (COJ), involves the ability to exert 20 to 50 pounds of force occasionally, 10 to 25 pounds of force frequently, and greater than 10 pounds of force constantly, to move objects. Stand: CONSTANT dynamic standing while sorting and folding articles. Static standing may occur up to 5 minutes uninterrupted while folding at the counter. Stand and walk are alternated regularly throughout the shift. Standing occurs on vinyl, non-skid painted concrete and industrial carpeted floors. Walk: OCCASIONAL walking up to 10 minutes when moving empty/full laundry racks to specified location throughout nursing home and when retrieving dirty laundry from laundry chutes. This is necessary approximately every 30 minutes and shared with other laundry staff. Walking occurs on vinyl, non-skid painted concrete and industrial carpeted floors. Sit: Sitting is not required and is only performed during breaks. Lift: Floor to Waist Level: CONSTANT up to 2 pounds for individual articles. FREQUENT 3-5 pounds for wet linens

and blankets. Waist to Shoulder Level: CONSTANT up to 2 pounds for individual articles. FREQUENT 3-5 pounds for stacks of clean linens, wet linens and blankets. OCCASIONAL 6- 15 pounds for stacks of larger linens.

Shoulder Level to Overhead: OCCASIONAL up to 2 pounds for hanging resident laundry on racks. Carry: OCCASIONAL carry of ounces to 15 pounds up to 5 feet to place stacks of clean linens on storage racks. Various carts are available to move items around the facility and minimize necessary carrying.

Claim No: ____________________


DOT No: 361.685-018 Page 3

Pull: FREQUENTLY items are pulled from the washer and dryer requiring 3-4 pulls per load. Items are rolled directly into a cart and never carried. Also see “Push”. Push: CONSTANT push/pull laundry carts loaded with dirty linens from chutes, push/pull dirty resident laundry from scale and push/pull dirty linens from sorting bins. Push/pull will also be used to load and unload washer and dryer and to move hanging clothes racks and to move clean laundry to folding table. Push/pull force is typically less than 10 pounds. SELDOM push/pull of rolling storage shelving requires a push/pull force up to 30 pounds. Push/pull occurs on vinyl, non-skid painted concrete and industrial carpeted floors. Controls: FREQUENTLY operate the hand controls on the washers/dryers (push button, knobs, dial turn, etc.) Climb: Climbing ladders and stairs is not required. Elevators are available. Balance: Balance is needed in relation to standing and walking while performing this position. Bend/Stoop: OCCASIONAL to FREQUENT bending up to 45 degree angle when loading and unloading washers, dryers and baskets. Opening to dryers and washers is at approximate waist hieght, 32-33”. Crouch: Worker may crouch in lieu of bend. Twist: FREQUENT twisting when loading and unloading washer and dryer. Twisting may be minimized by repositioning of the feet. Kneel: Required once a day to clean the lent traps in the dryers. Crawl: Not a requirement of this position. Handle/Grasp: CONSTANT handling and grasping of linens and clothes, both wet and dry. Grasping of carts and storage rack as needed requiring a stronger grasp. Fine Manipulation/Fingering: FREQUENT fine finger manipulation while folding linens and personal items belonging to residents. Feeling: Not a requirement of this position. Reach: Floor to waist level: OCCASIONAL when retrieving items from sorting carts and residents’ personal items from

scale. As needed for dropped articles. Waist to shoulder level: FREQUENT when retrieving items from dryer (drum is 50” deep) and washer and when folding articles of clothing/linens. FREQUENT reach to remove dirty clothes from laundry chute and to place clean items on shelves. Shoulder level to overhead: SELDOM when hanging clothes on hanging racks and placing linens on upper shelves.

Vision: Normal to corrected vision necessary when performing daily job tasks. Talk/Hear: Talking/hearing is needed to communicate with others and when taking instructions. Basic English is okay. Taste/Smell: Smell is needed to detect odors and soiled articles. Taste is not a requirement of this position.

Claim No: ____________________


DOT No: 361.685-018 Page 4

Environmental Factors: This position is performed 100% indoors. Cleaning soaps and chemicles are automatically fed into washer and dryer. Work Environment Access: Restroom, break area and parking available. Additional Comments:


Claim No: ____________________


DOT No: 361.685-018 Page 5

PHYSICIAN:










JOB ANALYSIS

Worker: _____________________

Claim No: ___________________

Job Title: Licensed Practical Nurse (LPN) -Wellness Nurse – Assisted Living DOT Title: Nurse, Licensed Practical DOT: 079.374-014 GOE: 10.02.01 SVP: 6 Industry: 573 Medical Services Employer: ________________________________ C/O Comprehensive Risk Management


Contact Person: Pamela Kaye Dooner Phone Number: 425.252.7623 Analyst: Stacy Lough, CDMS; Janet Snyder, CDMS Date: December 6, 2011 Job Description: Assists RN Wellness Nurse in providing education counseling and appropriate nursing services that assist village residents in living their lives. (Essential job tasks prioritized below)

a. Checks RSA (Resident Service Associate) Logs daily and coordinates 24 hour report. b. Provides or delegates, as appropriate, direct nursing services, treatment and assistance to residents. c. Works closely with the RN Wellness Nurse to provide staff development (RSA initial and ongoing training) and

supervision. d. Under the direction of the RN Wellness Nurse, completes the resident assessments prior to resident move in, 30

days after resident move in, semiannually and when there is a change in condition. e. Coordinates and schedules individual Resident Service Plan with each resident, his/her family and staff (30 day

and semiannual). Notifies family of recommended service package changes resulting from change in condition. f. Visits each resident quarterly and updates assessment if appropriate. g. Under the direction of the RN Wellness Nurse, executes the Quality Assurance Program. h. May provide shopping for residents. i. May assist with payroll and monthly resident billing. j. Performs other duties as assigned by management to meet changing job-related requirements.

Job Qualifications and Skills: Current Washington State LPN License; current necessary training under Washington State WAC regulations; High School diploma and three years of college or comparable education; one year experience; CPR; Food Handler’s Permit (may be obtained after hire).

Claim No: ____________________

Worker: ______________________ Job Analysis: Licensed Practical Nurse (LPN) -Wellness Nurse – Assisted Living

DOT No: 079.374-014 Page 2

High School Diploma/GED Required: Yes College Degree: N/A WA State Driver’s License: No Special Endorsements: N/A Clean Driving Record/Insurable: No Basic Computer Skills: Yes Speak/read/write English: Yes Keyboard Speed Required: N/A Software (name/version): Microsoft Office Suite Permits/Certifications: CPR, Food Handler’s Permit Type of Computer: PC Computer Operating System (type/version): Windows Licensure: WA State LPN Other:

Type of Machines, Tools, Special Equipment Used: Blood pressure cuff, thermometer, stethoscope, gloves, telephone, transfer belt, computer and medical equipment/supplies. Work Schedule: Full time.

PHYSICAL DEMANDS






Stand: OCCASIONAL to FREQUENT standing intermittent with walking is performed for up to two hours at a time while making rounds and checking on residents. Floor surfaces are generally carpet, linoleum, tile or concrete. Walk: OCCASIONAL to FREQUENT walking intermittent with standing is performed for up to two hours at a time while making rounds and checking on residents. Floor surfaces are generally carpet, linoleum, tile or concrete. Sit: OCCASIONAL to FREQUENT sitting for up to two hours while charting activities and medical information by computer and/or hand, inputting payroll and communicating with families. Lift: FREQUENT lift of 0-10 pounds for resident files and individual medical supplies. Lifting up to 25 pounds SELDOM required when stocking medical supplies. Lifting up to 50 pounds is rarely (1-2 time per month) required to assist or transfer residents. The correct use of a transfer belt is required to avoid injury to the resident or nurse. Lifting is performed from floor to shoulder level. Lifting over shoulder level is SELDOM. Carry: FREQUENT carrying up to 10 pounds when carrying resident treatment bag or other items. Carts are used for moving items weighing more than 10 pounds, such as medical equipment and supplies. Push/Pull: OCCASIONAL push/pull cart with medical equipment and supplies requiring up to 10 pounds of force. SELDOM push/pull cart loaded with heavier supplies requiring push/pull force up to 25 pounds. Typically cart rolls easily over concrete walkways, carpeting and tile.

Claim No: ____________________


DOT No: 079.374-014 Page 3

Push wheelchairs on a SELDOM basis. In regards to pushing wheelchairs the ratio is 8:1, so a 150 pound person in a wheelchair that weighs approximately 50 pounds would require 25 pounds of initial push force and then 20 pounds of kinetic force to maintain the pushing. CPR is performed on a SELDOM basis - on average 2-4 times per year. The amount of push force required for CPR chest compression is estimated at 110 pounds maximum. This is a shared force for each upper extremity and the trunk flexion force application would be a shared event, thus each body segment would apply a maximum of approximately 33 pounds of force. CPR is administered until EMS arrives – typically 1-4 minutes. Controls: OCCASIONAL intermittent use of various hand controls with knobs to turn, buttons to push and switches to flip as needed for blood pressure cuff and various other medical equipment. The use of foot controls is SELDOM. Climb: Climbing stairs and ladders is not a requirement of this position. Balance: Balance is within normal limits. Bend/Stoop: FREQUENT bending required when providing treatment to residents, administering medications, taking vital signs and assisting seated residents. Must able to perform CPR. Crouch, bend, stoop and kneel may often be used interchangeably at employee’s discretion. Crouch: On a rare basis, may need to kneel or crouch to retrieve items at floor level. Crouch, bend, stoop and kneel may often be used interchangeably at employee’s discretion. Twist: OCCASIONAL twisting at the waist may occur when providing medical treatments, assisting in transfer or when applying/changing daily bandages and leg wraps. Kneel: On a rare basis may need to kneel or crouch to retrieve items at floor level. Must be able to perform CPR. Crouch, bend, stoop and kneel may often be used interchangeably at employee’s discretion. Crawl: Crawling is not a requirement of this position. Handle/Grasp: CONSTANT grasping when handling pens/pencils for documenting information into medical charts, when handling paperwork and while using various medical supplies/equipment (stethoscope, thermometer, medications, syringes, etc.). SELDOM forceful grasp used when pushing resident in wheelchair. Grasping for transferring patients occurs on an infrequent monthly basis. Fine Manipulation/Fingering: OCCASIONAL fine finger manipulation while using the computer and telephone and when performing first aid and administering shots. Feeling: Must be able to take vitals (i.e. feel pulse) and must be able to detect temperature differences in skin. Reach: Reaching OCCASIONALLY at all levels from standing and seated positions up to full arm extension when administering to residents who are bedridden and seated, reaching for supplies and using phone. Reaching above shoulder height is not necessary from standing position. Vision: CONSTANT for doing job effectively and correctly. Normal or corrected to normal vision is required. Talk/Hear: Necessary for communicating with others, safety awareness and for taking instructions from physicians and supervisor.

Claim No: ____________________


DOT No: 079.374-014 Page 4

Taste/Smell: Smell is required and necessary to detect dangerous odors when providing wound treatment and performing health assessment. Environmental Factors: Work is performed primarily indoors. Walking between different residential units and the office building will expose worker to weather conditions. Will be exposed to household chemicals, human waste and bodily fluids, infection and viruses and/or sanitation chemicals. May use safety gloves for patient care, sanitation and laundry. Work Environment Access: Wheelchair accessible. Restrooms, parking and break area provided. Additional Comments:


Claim No: ____________________


DOT No: 079.374-014 Page 5

PHYSICIAN:










JOB ANALYSIS

Worker: ____________________

Claim No: __________________

Job Title: Licensed Practical Nurse (LPN), Primary Care - Nursing Home DOT Title: Nurse, Licensed Practical DOT: 079.374-014 GOE: 10.02.01 SVP: 6 Industry: 573 Medical Services Employer: __________________________________ C/O Comprehensive Risk Management


Contact Person: Pamela Kaye Dooner Phone Number: 425.252.7623 Analyst: Stacy Lough, CDMS; Janet Snyder, CDMS Date: November 17, 2011 Job Description: (Essential job tasks prioritized) The LPN will direct, administer and record the care given to residents in an assigned section of the nursing facility. In this position, the worker's primary responsibilities are:

Documentating and directing the other nursing staff in performing care for the resident. Communicate with family members regarding the progress of the resident. Assist visiting physicians in rounds. Draw blood and obtain fluids to submit for lab work. May be required to complete intravenous infusion/injection. Record and issue appropriate medications. May be required to work with Alzheimer's residents who are not cooperative. Record and monitor all progress of residents and communicate with physicians. May be required to assist in passing out trays to residents in dining area and assist in feeding. Monitor work of other nursing staff in unit to ensure thoroughness. Required to use telephones to communicate with physicians, arrange for transportation for doctor appointments and

contact families. Make rounds to ensure cleanliness and proper care to residents. Coordinate care of residents. Manages all NAC staff in section. Assists staff members according to needs. Follow set protocol in emergency situation.

Claim No: ____________________

Worker: ______________________ Job Analysis: Licensed Practical Nurse (LPN), Primary Care - Nursing Home

DOT No: 079.374-014 Page 2

Job Qualifications and Skills: Must be licensed as an LPN. Ability to speak English. Ability to perform CPR. High School Diploma/GED Required: Yes College Degree: N/A WA State Driver’s License: No Special Endorsements: N/A Clean Driving Record/Insurable: No Basic Computer Skills: Yes Speak/read/write English: Yes Keyboard Speed Required: N/A Software (name/version): MS Office & Proprietary Permits/Certifications: CPR, Food Handler’s Permit Type of Computer: PC Computer Operating System (type/version): Windows Licensure: WA State LPN Other:

Type of Machines, Tools, Special Equipment Used: Computer, telephone, gowns, goggles, gloves, masks, Accucheck (Blood Sugar), scale, blood pressure cuff, bladder scanner, pulse oximeter, thermometer, oxygen concentration, IV pumps, portable oxygen and various first aid supplies and equipment. Work Schedule: Full Time

PHYSICAL DEMANDS






Stand: OCCASIONAL standing intermittent with walking is performed for up to two hours at a time while making rounds and checking on residents. Employer states static stand up to 2 minutes at one time when administering treatments. Twice per week static standing is required up to 45 minutes for longer treatments. Floor surfaces are generally carpet, linoleum, tile or concrete. Walk: FREQUENT walking is performed intermittent with standing for approximately three to four hours per day on carpet and vinyl flooring. Sit: OCCASIONAL while charting activities and medical information by computer and/or hand, when phoning doctors, taking orders and communicating with families. Lift: FREQUENT lift up to10 pounds for resident files and supplies. Lifting 10-25 pounds OCCASIONALLY required for medical supplies/equipment. SELDOM lifting up to 50 pounds to assist and transfer residents with transfer belt. The correct use of a transfer belt is required to avoid injury to the resident or nurse. Vera Lift and Vander Lifts are used to minimize weight. Lifting primarily performed from floor to shoulder level. Lifting over shoulder level is SELDOM. Carry: FREQUENT up to 5 pounds. OCCASIONAL 5-10 pounds to move items from one location in the facility to another. Carts are available for heavier supplies and/or equipment.

Claim No: ____________________


DOT No: 079.374-014 Page 3

Push/Pull: OCCASIONAL push/pull cart with medical equipment and supplies requiring up to 10 pounds of force. SELDOM push/pull cart loaded with heavier supplies requiring push/pull force up to 25 pounds. Typically cart rolls easily over concrete walkways, carpeting and tile. Push wheelchairs on an OCCASIONAL basis. In regards to pushing wheelchairs the ratio is 8:1, so a 150 pound person in a wheelchair that weighs approximately 50 pounds would require 25 pounds of initial push force and then 20 pounds of kinetic force to maintain the pushing. Each employee performs CPR on a SELDOM basis. CPR is needed 1-2 times per week throughout the facility and multiple employees perform this function. The amount of push force required for CPR chest compression is estimated at 110 pounds maximum. This is a shared force for each upper extremity and the trunk flexion force application would be a shared event, thus each body segment would apply a maximum of approximately 33 pounds of force. CPR is administered until EMS arrives – typically 1-4 minutes. Controls: FREQUENT use of various hand controls with knobs to turn, buttons to push and switches to flip as needed for blood pressure cuff and various other medical equipment. The use of foot controls may be required for hydraulic beds, wheelchair brakes, etc. Climb: Climbing stairs and ladders is not required – elevators and ramps are available. Balance: Balance is within normal limits. Bend/Stoop: OCCASSIONAL bending may occur when providing treatment to residents, administering medications, taking vital signs and assisting seated residents, etc. Must be able to perform CPR. Crouch, bend, stoop and kneel may often be used interchangeably at employee’s discretion. Crouch: Not a required physical demand of this position. Twist: OCCASIONAL twisting may occur while providing patient care. Kneel: Must be able to perform CPR. Crawl: Not a required physical demand of this position. Handle/Grasp: FREQUENT handling paperwork, pens/pencils, telephone and various medical supplies/equipment (i.e. stethoscope, thermometer, medications, syringes, etc). Fine Manipulation/Fingering: OCCASIONAL fine finger manipulation while using the computer keyboard, writing, and when performing first aid, administering shots and medications. Feeling: OCCASIONAL to assess residents’ vitals (i.e. feel pulse and skin temperature). Reach: Above shoulder level – OCCASIONAL when attending patients with tubes and IVs and to obtain supplies on shelves. Waist to shoulder level - FREQUENT while documenting charts, drawing blood and providing care to residents. Below waist level– OCCASIONAL to obtain clerical supplies or charting information in drawers.

Claim No: ____________________


DOT No: 079.374-014 Page 4

Vision: Normal or corrected to normal required. Must be able to read labels, doctor’s instructions, medication orders, charts and medical history. Talk/Hear: Necessary for safety awareness and for communicating and taking instructions from physicians, labs, pharmacists, families and supervisor. Ability to read, write, and speak English. Taste/Smell: Smell is required and necessary to detect dangerous odors, provide wound treatment and to perform health assessment/diagnosis. Environmental Factors: Work is performed primarily indoors. Will be exposed to household and hospital chemicals, human waste and bodily fluids, infection and viruses and/or sanitation chemicals. May use safety gloves for patient care, sanitation and laundry. May use mask, goggles and gowns. Possible exposure to needle pricks. Work Environment Access: Wheelchair accessible. Restrooms, parking and break area provided. Additional Comments:


Claim No: ____________________


DOT No: 079.374-014 Page 5

PHYSICIAN:










JOB ANALYSIS

Worker: ____________________

Claim No: __________________

Job Title: Maintenance DOT Title: Maintenance Repairer, Building DOT: 899.381-010 GOE: 05.10.01 SVP: 7 Industry: 138 Any Industry Employer: _________________________ C/O Comprehensive Risk Management


Contact Person: Pamela Kaye Dooner Phone Number: 425.252.7623 Analyst: Stacy Lough, CDMS; Janet Snyder, CDMS Date: November 18, 2011 Job Description: (Essential job tasks prioritized below) Repair and maintain physical structure of senior housing community consisting of 300 plus residential units, common areas and facilities. General maintenance may require plumbing repairs such as unclogging hair traps, unpluging toilets and repair washer/dryers, refrigerators and stoves. May be required to maintain and replace electrical outlets, and light bulbs. May be required to remove furniture and clothing from rooms no longer occupied. May be required to paint interior or exterior of facility. May be required to install and check batteries of smoke alarms. May be required to assist Fire Marshall with inspections. May be required to maintain the grounds of the facility. May assist in holiday decoration installation and removal. Job Qualifications and Skills: Two plus years experience in maintenance and repair; well rounded knowledge of electrical, plumbing and appliances; acceptable background check. High School Diploma/GED Required: Yes College Degree: N/AWA State Driver’s License: Yes Special Endorsements: N/A Clean Driving Record/Insurable: No Basic Computer Skills: N/A Speak/read/write English: Yes Keyboard Speed Required: N/A Software (name/version): N/A Permits/Certifications: N/A Type of Computer: N/A Computer Operating System (type/version): N/A Licensure: N/A Other:

Claim No: ____________________

Worker: ______________________ Job Analysis: Maintenance

DOT No: 899.381-010 Page 2

Type of Machines, Tools, Special Equipment Used: Various power tools and hand tools and electrical and plumbing supplies. Hand truck, dolly and carts. May be required to operate a vehicle. Work Schedule: Full time.

PHYSICAL DEMANDS






Stand: OCCASIONAL static standing is performed up to 15 minutes at a time when making repairs and up to two hours per day on varying surfaces such as carpet, linoleum, tile, concrete, gravel, dir, and grass. Standing is intermittent with walking and combined occur on a CONSTANT basis. Walk: Walking is FREQUENT and alternated with static standing. Walk and stand occur together CONSTANTLY. Walking on varying surfaces such as carpet, linoleum, tile, concrete, dirt and grass to move around the facility, work area and maintenance room. Sit: Sitting is only performed on breaks and at lunch. Lift: FREQUENT lift up to 10 pounds for tools and supplies. OCCASIONAL lifting 10 to 25 pounds (cans of paint and various other equipment and supplies). OCCASIONAL lifting up to 50 pounds when lifting various supplies or equipment. Assistance is available in moving furniture that weighs over 50 pounds, so that the worker will not be lifting over 50 pounds as part of the shared weight. Hand truck, dolly and carts are available to move heavier items. Carry: CONSTANTLY wear a tool belt containing tools weighing up to 15 pounds. OCCASIONAL carry up to 25 pounds of various supplies including cans of paint, tool box, equipment and supplies. SELDOM carry between 25 and 50 pounds when moving a case of paper, furniture and other items out of vacated apartments. The distance items are carried may be from 50 to 100 feet. Elevators are available if items need to be moved to another floor. For items weighing over 50 pounds there is assistance available. Push: OCCASIONAL pushing when moving furniture. Carts available for moving heavier equipment. Pull: OCCASIONAL pulling when moving furniture. Carts be available for moving heavier equipment. Controls: OCCASIONALLY operate hand and foot controls when using vehicles, power tools or testing equipment. Climb: Elevators are available along with stairs for emergency situtations or at employee’s discretion. SELDOM climb ladders when decorating, painting or performing other job duties.

Claim No: ____________________


DOT No: 899.381-010 Page 3

Balance: Balance is needed when working on the ladder. Bend/Stoop: FREQUENT bending occurs when repairing pipes under sinks, installing wall outlets, painting, assisting residents, and completing various work orders. Crouch/Kneel: OCCASIONAL crouching occurs when repairing pipes under sinks, installing wall outlets, painting and completing other work orders. Twist: OCCASIONAL twisting may occur at waist when performing carpentry work or working in tight spaces when repairing appliances. SELDOM twist at neck level when driving. Crawl: SELDOM crawling when working under appliances and in titght spaces. Handle/Grasp: CONSTANT handling of various tools and supplies during daily job tasks. Forceful grasp is intermittent when using hand tools, moving furniture and performing repairs. Fine Manipulation/Fingering: OCCASIONAL fine finger manipulation while working on wiring, manipulating small parts for repairs and/or to complete projects and paperwork. Feeling: Within normal limits. Reach: FREQUENT reaching above shoulder height when changing light bulbs, painting walls or ceiling and when climbing ladders. FREQUENT reaching between shoulder and waist height when painting or performing tasks required for maintenance. FREQUENT reaching below waist height when performing maintenance tasks on toilets and sinks, performing electrical testing and to obtain supplies. Vision: Normal or corrected to normal vision is necessary for doing the job effectively and correctly. Talk/Hear: Necessary for communicating and taking instruction from others. Taste/Smell: Smell required when evaluating electrical and plumbing repair needs. Taste not a requirement for this position. Environmental Factors: May be some whole body vibration when operating equipment. May be subject to changes in temperature when outdoors and when going from indoors to outdoors. 80% of the position is performed indoors and 20% is performed outdoors, alternating throughout the shift. Exposure to paint, paint thinner and other maintenance chemicles may occur. Work Environment Access: Parking, restrooms and break area provided. Additional Comments: Note: This description represents the requirements of the job based on observations, discussions with the employer representatives, incumbents and other professional resources. On occasion, practicality and feasibility prevent the direct observation and/or gathering of objective, quantifiable data. For this reason, a “best estimate” may have been used.

Claim No: ____________________


DOT No: 899.381-010 Page 4

PHYSICIAN:










(253) 661-5550 (206) 203-0057 [fax]


(253) 661-5550 (360) 786-8045 [fax]

JOB ANALYSIS

Worker: Claim No:

Job Title: Medical Records Clerk DOT: 245.362-010 DOT Title: Medical-Records Clerk GOE: 07.05.03 SVP: 4 Location: ________________________________







Claim No: ___________________ Worker: ___________________ Job Analysis - Medical Records Clerk

DOT No.: 245.362-010 Page 2 Job Description: (Essential job tasks prioritized below.) Responsible for medical records information on each individual resident and incorporating the nursing staff information into these records. Process computerized resident plan of care and multidisciplinary flowsheets, updating, printing and distributing care plan flowsheets and problem sheets. Reviewing charts of discharged residents for deficiencies and monitoring to ensure compliance for correction of deficient documentation. Coordinate and fill in chronological order each section of the residents record. May be required to send charts. Maintain effective communication with others, both inside and outside the department to give or obtain needed information or coordinate activities of residents. Competencies required to perform this occupation: Attaining Precise Set Limits, Tolerances, and Standards: Work situations that involve adhering to and achieving exact levels of performance, using precision measuring instruments, tools, and machines to attain precise dimensions. Preparing exact verbal and numerical records. Complying with precise instruments and specifications for materials, methods, procedures, and techniques to attain specified standards. Job Qualifications: Types of Machines, Tools, Special Equipment Used: Computer and telephone. Materials, products, subject matter, services: 891, Clerical Services Industry Designation: 573, Medical Service Work Schedule:

PHYSICAL DEMANDS Strength Level: Medium Stand: Occasional standing and walking is performed for approximately one hour per day on a variety of floor surfaces including carpeting, linoleum and tile. Walk: Occasional walking and standing is performed for approximately one hour per day on a variety of floor surfaces including carpeting, linoleum and tile. Sit: Frequent sitting at a desk and computer to input and update information for three to six hours out of an eight hour work day. Lift: Frequentl lifting up to 10 pounds of files, charts, office materials and supplies. Occasional lifting of a box of records and supplies up to 50 pounds. Carry: Occasionally carry resident charts from one location to another a distance of 100 feet, depending upon the facility size. When transferring several charts a rolling cart can be utilized.


DOT No.: 245.362-010 Page 3 Push: Rare pushing/pulling when opening and closing desk drawers or moving a cart filled with medical records from one location to another. Pull: See “push” Controls: Intermittent use of hand controls on the computer and the telephone. No use of foot controls. Climb: Climbing stairs and ladders is not a requirement of this position. Balance: Balance is needed in relation to standing, walking and sitting while performing this position. Bend/Stoop: Occasional bending/stooping when retrieving charts from lower shelves. Crouch: Crouching is not a requirement of this position, may be performed at the worker's discretion. Twist: Twisting is not a requirement of this position. Kneel: Kneeling is not a requirement of this position. Crawl: Crawling is not a requirement of this position. Handle/Grasp: Constantly handling various size objects as medical charts and pen and paper. Occasional grasping of residents’ charts. Fine Manipulation/Fingering: Frequent fingering when keyboarding. Feeling: Within normal limits to feel/grasp files and to file records properly folders. Reach: Occasional reaching above shoulder height when retrieving medical charts from upper shelves. Occasional reaching between shoulder and waist height may occur when documenting information and compiling paperwork. Occaional reaching below wasit while retrieving resident charts from lower shelves. Vision: Necessary for doing the job effectively and correctly. Talk/Hear: Necessary for communicating and taking instruction from doctors and supervisor. Taste/Smell: Taste and Smell are not requirements for this position. Environmental Factors: Temperature controlled environment - the worker will perform the entire job indoors. May be exposed to some infectious diseases and cleaning agents. Work Environment Access:



JOB ANALYSIS

Worker: _______________________ Claim No: _____________________

Job Title: Nurse Assistant Certified (NAC) - Nursing Home DOT Title: Nurse Assistant DOT: 355.674-014 GOE: 10.03.02 SVP: 4 Industry: 573 Medical Services Employer: __________________________________ C/O Comprehensive Risk Management


Contact Person: Pamela Kaye Dooner Phone Number: 425.252.7623 Analyst: Stacy Lough, CDMS; Janet Snyder, CDMS Date: November 17, 2011 Job Description: (Essential job tasks prioritized) Provide direct care to nursing home residents, primarily for their activities of daily living but also to include some medical care. Assist residents in and out of bed and into wheelchair with the correct use of the transfer belt (may require the assistance of another aid depending on weight and physical/cognitive abilities of resident). Assist residents in bathing. Assist residents in dressing and undressing. Assist residents in using bathroom facilities and peri care. Take vital signs of residents (i.e. temperature and blood pressure) and record information. Assist residents to dining area for meals. May be required to assist in feeding residents and documenting intake of nourishment. Strip bedding and replace with clean linens. May be required to assist in personal grooming of residents (i.e. brush hair, trim finger nails and toe nails). If resident is bedridden due to illness, aid may be required to turn resident intermittently. May be required to clean bedpans and empty catheter bags. Required to document information regarding the each resident’s health, input/output and any change of medical condition. Job Qualifications and Skills: Nurse Assistant Certification or completed training (allow 120 days to test and receive certification). High School Diploma/GED Required: Yes College Degree: N/A WA State Driver’s License: No Special Endorsements: N/A Clean Driving Record/Insurable: N/A Basic Computer Skills: N/A Speak/read/write English: Basic English skills needed. Keyboard Speed Required: N/A Software (name/version): N/A Permits/Certifications: CPR, Food Handler’s Permit;

NAC Type of Computer: N/A Computer Operating System (type/version): N/A Licensure: N/A Other:

Claim No: ____________________

Worker: ______________________ Job Analysis: Nurse Assistant Certified (NAC) - Nursing Home

DOT No: 355.674-014 Page 2

Type of Machines, Tools, Special Equipment Used: Blood pressure cuff, gloves, medical supplies, Vera Lift and Vander Lift and bathing chairs. Work Schedule: Full time.

PHYSICAL DEMANDS






Stand: FREQUENT standing throughout the work day. Static standing occurs for periods up to 5 minutes at one time. Dynamic standing occurs for periods up to 15 minutes. Floor surfaces are generally carpet, linoleum, tile or concrete. Static and dynmaic standing combined with walking occur CONSTANTLY throughout the work day. Standing positions are alternated on a frequent basis. Walk: FREQUENT walking in assigned work area on carpeted, linoleum and tile floors. Walk combined with dynamic and static stand occur CONSTANTLY. Sit: OCCASIONAL sitting for periods no more than 10-15 minutes at a time while feeding residents, visiting with residents and charting. Sitting typically does not occur more than one hour total each shift. Lift: Waist to shoulder level CONSTANT - up to 5 pounds of residents’ personal items (i.e. clothing, food items, medical charts, notebooks, linens and supplies). FREQUENT – 5 to10 pounds of supplies and equipment. OCCASIONAL - up to 50 pounds when lifting heavier equipment and when transferring a resident or when assisting a resident in bathing or dressing. Employer states typically two aids are utilized when resident is unusually heavy or combative. Over 50 pounds – in this scenario motorized Vander Lifts and Vera Lifts are utilized.

Claim No: ____________________


DOT No: 355.674-014 Page 3

Figure 1 Vera-Lift Figure 2 Vander-Lift Figure 3 Bathing Chair lift Lift: Below waist and above shoulder Level SELDOM – up to 5 pounds for supplies located at lower and higher levels. Carry: FREQUENTLY carry up to 5 pounds of a residents’ personal items (i.e., clothing, food items, medical charts). OCCASIONALLY carry 6-15 pounds (trays, linens and medical equipment). Carts are used to move items weighing more than 15 pounds. Push/Pull: FREQUENT push/pull empty Vander-Lift and Vera-Lift to individual rooms as needed. OCCASIONAL push/pull cart with medical equipment and supplies requiring up to 10 pounds of force. SELDOM push/pull cart loaded with heavier supplies requiring push/pull force up to 25 pounds. Typically cart rolls easily over concrete walkways, carpeting and tile. Push wheelchairs on a FREQUENT basis. In regards to pushing wheelchairs the ratio is 8:1, so a 150 pound person in a wheelchair that weighs approximately 50 pounds would require 25 pounds of initial push force and then 20 pounds of kinetic force to maintain the pushing. Each employee performs CPR on a SELDOM basis. CPR is needed 1-2 times per week throughout the facility and multiple employees perform this function. The amount of push force required for CPR chest compression is estimated at 110 pounds maximum. This is a shared force for each upper extremity and the trunk flexion force application would be a shared event, thus each body segment would apply a maximum of approximately 33 pounds of force. CPR is administered until EMS arrives – typically 1-4 minutes. Controls: OCCASIONALLY use blood pressure gauge and thermometer, office equipment and other nursing/medical equipment. The use of both hand and foot controls is required (i.e. wheelchair brakes, hydraulic beds, etc). Climb: Climbing stairs and ladders is not a requirement of this position. Balance: Balance is required within normal limits. Bend/Stoop: OCCASIONAL bending occurs while taking vital signs, assisting residents in bathing, providing peri care, making beds, etc. Must be able to perform CPR.. Crouch: OCCASIONAL crouching/squatting may occur while bathing a resident. Twist: OCCASIONAL twisting may occur at the waist while transferring residents and performing other duties. Kneel: OCCASIONAL kneeling may occur while bathing a resident. Must be able to perform CPR. Crawl: Crawling is not a requirement of this position.

Claim No: ____________________


DOT No: 355.674-014 Page 4

Handle/Grasp: CONSTANT grasping/handling when assisting residents, handling residents’ personal items, using blood pressure gauge, thermometer, eating utensils and when handling linens. Fine Manipulation/Fingering: OCCASIONAL fine finger manipulation occurs while documenting residents’ medical charts and as needed for buttons and laces when dressing. Also used for operating blood pressure cuff and other medical equipment. Feeling: Must be able to sense differences and temperature and take vitals. Reach: Occurs at all levels up to full arm extension. Above shoulder level – SELDOM when reaching for medical records or supplies located on shelves. Waist to shoulder level – FREQUENT when assisting residents in eating, changing bed linens, taking vital signs. Below waist level – FREQUENT assisting residents with peri-care and bathing. As needed for reaching items located on lower shelves. Vision: Normal or corrected to normal vision is necessary for doing the job effectively and correctly. Talk/Hear: The ability to speak and hear is necessary for communicating with residents and other aids and for taking instructions from Charge Nurse and requests from residents. Taste/Smell: Must be able to detect emergencies and determine the cleanliness of residents. Environmental Factors: Work is performed primarily indoors. Will be exposed to household and hospital chemicals, human waste and bodily fluids, infection and viruses and/or sanitation chemicals. May use safety gloves for patient care, sanitation and laundry. May use mask, goggles and gowns. Note: This description represents the requirements of the job based on personal observations, discussions with the employer representatives, incumbents and other professional resources. On occasion, practicality and feasibility prevent the direct observation and/or gathering of objective, quantifiable data. For this reason, a “best estimate” may have been used.

Claim No: ____________________


DOT No: 355.674-014 Page 5

PHYSICIAN:










(253) 661-5550 (206) 203-0057 [fax]


(253) 661-5550 (360) 786-8045 [fax]

JOB ANALYSIS

Worker: ___________________ Claim No: ___________________

Job Title: Physical Therapy Assistant DOT: 355.354-010 DOT Title: Physical Therapy Aide GOE: 10.03.02 SVP: 4 Location: _____________________________________________







Claim No: ___________________ Worker: ___________________ Job Analysis - Physical Therapy Assistant

DOT No.: 355.354-010 Page 2 Job Description: (Essential job tasks prioritized below.) Assists residents from room to physical therapy, either by wheelchair or walking with ambulatory residents. Required to transfer residents prior to performing various exercises with the resident. May utilize the assistance of another aid if necessary. Assist residents with range of motion exercises, walking and light aerobic activities. Document progress of individual residents. Assists physical therapist in administering treatments, tests and evaluations of elderly residents. Employee must be physically able to tolerate physical exertion. Also employee must be able to demonstrate and participate with the residents in light aerobic exercises or range of motion exercises. Competencies required to perform this job include: Dealing with People: Work situations that involve interpersonal relationships in a job setting beyond giving and receiving work instructions. Attaining Precise Set Limits, Tolerances, and Standards: Work situations that involve adhering to and achieving exact levels of performance, using precision measuring instruments, tools, and machines to attain precise dimensions. Preparing exact verbal and numerical records. Complying with precise instruments and specifications for materials, methods, procedures, and techniques to attain specified standards. Job Qualifications: Types of Machines, Tools, Special Equipment Used: Gym equipment, computer and telephone. Materials, products, subject matter, services: 926, Medical Assistant, Aide, Attendant Services Industry Designation: 573, Medical Services Work Schedule:

PHYSICAL DEMANDS Strength Level: Heavy Stand: Occaional standing, up to three hours per day on various surfaces (carpet, linoleum or tile). Walk: Occasiaonl walking, from two to three hours per day on surfaces varying from carpeting to linoleum or tile. Sit: Occasional sitting, from one to two hours per day usually while documenting information regarding residents or on break. Lift: Frequent lifting up to 10 pounds when assisting resident in performing range of motion activities. Occasional lifting of 10 to 25 pounds while working with residents. Occasional to frequent lifting of 25 to 50 pounds when transferring residents. Lifting up to 100 pounds is occasional while transferring residents. The use of transfer belt is always required.


DOT No.: 355.354-010 Page 3 Carry: Frequent carrying up to 10 pounds when assisting resident in performing range of motion activities. Occasional carrying of 10 to 25 pounds while working with residents. Occasional to frequent carrying of 25 to 50 pounds when transferring residents. Employee is required to utilize the use of transfer belt. Occasionally carrying up to 100 pounds while transferring residents. Push: Occasional pushing/pulling occurs transporting residents in wheelchairs. Pull: See "push" Controls: Occasional use of limited hand controls to flip a switch, push a button, etc. Climb: Climbing stairs and ladders is not a requirement of this position. Balance: Must be able to balance when transferring a resident. Bend/Stoop: Frequent bending/stooping is performed while assisting residents with exercises. Crouch: Occasional crouching/squatting occurs while assisting residents with exercises. Twist: Occasional twisting may occur while demonstrating exercises to residents. Kneel: Occasional kneeling may occur while assisting residents with exercises. Crawl: Crawling is used only when retrieving items from lower levels. Handle/Grasp: Frequent handling is used while assisting residents with exercises. Frequent grasping is used when documenting progress of residents. Fine Manipulation/Fingering: Occasional fine finger manipulation is used while documenting progress of resident. Some facilities may utilize a computer for charting. Feeling: Within normal limits to handle and grasp, and while using hot pads. Reach: Occasional reaching at and above shoulder height while assisting residents with range of motion exercises or light aerobic exercises. Reaching below shoulder height also occurs while assisting with range of motion exercises. Vision: Normal to correctable vision is necessary for doing the job effectively and correctly. Talk/Hear: The ability to talk/hear is necessary for communicating with the residents and other aids and for taking instructions from physical therapist. Taste/Smell: Not a requirement of this position. Environmental Factors: Primarily indoor environment; may occasionally assist residents with some outdoor walking. May be exposed to some infectious diseases and cleaning solutions.


DOT No.: 355.354-010 Page 4 Work Environment Access: Access to parking, restrooms, and breakroom. Wheelchair accessible. Additional Comments: Note: This description represents the requirements of the job based on observations, discussions with the employer representatives, incumbents and others. On occasion, practicality and feasibility prevent the direct observation and/or gathering of objective, quantifiable data. For this reason, a “best estimate” may have been used.



(253) 661-5550 (206) 203-0057 [fax]


(253) 661-5550 (360) 786-8045 [fax]

JOB ANALYSIS

Worker: _____________________ Claim No: _____________________

Job Title: Receptionist DOT: 237.367-038 DOT Title: Receptionist GOE: 07.04.04 SVP: 4 Location: ________________________________


Contact Person: Pamela Dooner Phone Number: 425-252-7623 Analyst: Janet Snyder Date: 9/13/06





Claim No: ____________________ Worker: ____________________ Job Analysis - Receptionist

DOT No.: 237.367-038 Page 2 Job Description: (Essential job tasks prioritized below.) The receptionist will greet and direct visitors and residents within the facility. The Receptionist will answer and direct all calls coming into the facility's main switch board. The Receptionist will assist all visitors that come into the facility. The Receptionist will know the proper procedures for fire drills and will notify security of any problems. The Receptionist may deliver packages, flowers, etc. to residents as needed at the front desk. Distribute mail in mail room to residents' mail slots and staff mail boxes. Other clerical duties related to mail distribution. Competencies required to perform the job include: Repetitive or Short Cycle Work: Work situations where performing a few routine and uninvolved tasks over and over again according to set procedures, sequence, or pace with little opportunity for diversion or interruption. Interaction with people is included when it is routine, continual or prescribed. Dealing with People: Work situations that involve interpersonal relationships in a job setting beyond giving and receiving work instructions. Job Qualifications: Types of Machines, Tools, Special Equipment Used: Computer, phone system, and public announcement system. Materials, products, subject matter, services: 891, Clerical Services Industry Designation: 249, Clerical and Kindred Work Schedule:

PHYSICAL DEMANDS Strength Level: Sedentary Stand: Occasional standing and walking, approximately one hour per shift. Work surfaces are carpeting and linoleum. Walk: See "stand" Sit: Constant sitting for seven hours out of an eight hour work day using a counter level surface and an office chair. Lift: Occasionally lift deliveries for residents weighing no more than five to 10 pounds and potentially carrying these items for up to 100 feet at a time. Carry: See "lift"


DOT No.: 237.367-038 Page 3 Push: Intermittent pushing and pulling to open/close doors and drawers may be necessary. Pull: See "push" Controls: Intermittent use of the hand controls on the telephone, headset, computer, public announcement system. Climb: Climbing stairs and ladders is not a requirement of this position. Balance: Balance is required within normal limits to perform the standing, walking, sitting, etc. in this position. Bend/Stoop: Rare bending may be used when retrieving dropped items from drawers. Crouch: Not a requirement of this position. Twist: Not a requirement of this position. Kneel: Not a requirement of this position. Crawl: Not a requirement of this position. Handle/Grasp: Frequent handling and grasping when writing messages. Fine Manipulation/Fingering: Occasional to frequent fingering will be used when typing. Feeling: Within normal limits to use hands in job tasks, grasping objects, feeling computer keys to depress, etc. Reach: Occasaional reaching above shoulder height when directing visitors to a location or distributing mail. Occasionaly eaching below shoulder height when retrieving supplies. Vision: Normal to correctable vision is constantly required when monitoring the outgoing and incoming visitors and residents. Talk/Hear: The abiltity to speak and hear is constantly required when communicating with others and when communicating with residents and visitors. Taste/Smell: Not a requirement of this position. Environmental Factors: Inside air conditioned environment. Work Environment Access: Access to restroom, breakroom and parking. Additional Comments:


DOT No.: 237.367-038 Page 4 Note: This description represents the requirements of the job based on observations, discussions with the employer representatives, incumbents and others. On occasion, practicality and feasibility prevent the direct observation and/or gathering of objective, quantifiable data. For this reason, a “best estimate” may have been used.



(253) 661-5550 (206) 203-0057 [fax]


(253) 661-5550 (360) 786-8045 [fax]

JOB ANALYSIS

Worker: _____________________ Claim No: _____________________

Job Title: Recreation/Activities Therapy Assistant DOT: 076.124-014 DOT Title: Recreational Therapist GOE: 10.02.02 SVP: 6 Location: __________________________________







Claim No: ____________________ Worker: ____________________ Job Analysis - Recreation/Activities Therapy Assistant

DOT No.: 076.124-014 Page 2 Job Description: (Essential job tasks prioritized below.) Perform duties involving the planning and implementation of activities/programs, which meet the needs and interests for the physical, mental and psycho-social well-being of the residents; i.e., Horticulture classes, group exercises, crafts and woodworking. Maintain documentation as required by the State and Federal regulations. Assist with resident outings. Coordinate and instruct participation of volunteers with residents. May be required to care for facility pets; i.e., dogs, cats, fish and birds. Assist in maintenance of recreation equipment and supplies. This is a somewhat physical position based on the required amount of walking and standing. Transferring of patients does not occur often but employee is required to know the correct way to transfer residents so as not to injure the resident or themselves. Typically there is more than one Recreation Therapy Assistant available. Competencies required to perform the job include: Directing, Controlling or Planning Activities of Others: Work situations where accepting responsibility for formulating plans, designs, practices, policies, methods, regulations, and procedures for operations or projects; negotiating with individuals or groups for agreements or contracts; and supervising workers to implement plans and control activities. Dealing with People: Work situations that involve interpersonal relationships in a job setting beyond giving and receiving work instructions. Variety Of Duties: Work situations that involve frequent changes of tasks using different techniques, procedures, or degrees of attentiveness without loss of efficiency or composure. Job Qualifications: Types of Machines, Tools, Special Equipment Used: Operate a van, use paints brushes, and other craft supplies. Materials, products, subject matter, services: 924, Nursing, Dietetic, and Therapeutic Services Industry Designation: 573, Medical Services Work Schedule:

PHYSICAL DEMANDS Strength Level: Heavy Stand: Occasional standing, for two to three hours per work day. Walk: Occasional walking, for up to three hours per work day Sit: Occasional sitting occurs when driving the van and while documenting information regarding the residents. May sit for one to two hours per work day.


DOT No.: 076.124-014 Page 3 Lift: Occasional lifting up to 10 pounds to lift various supplies used in recreational activities; i.e., paints, brushes, etc. Rare lifting of 11 to 50 pounds. Rare lifting over 50 pounds to transfer resident from wheelchair with the assistance of others. Use of a transfer belt is required. Carry: Occasional carrying up to 10 pounds to lift and carry supplies used for recreation activities. Carrying over 10 pounds is not required. Push: Occasional pushing/pulling when assisting residents to recreation hall while resident is seated in wheelchair. Pull: See "push" Controls: Occasionally use hand and foot controls when driving the van. Climb: Rarely climb stairs or short stool to obtain items on higher shelves. Balance: Balance is required within normal limits to perform the standing, walking, sitting, etc. in this position. Must be able to balance if transferring a resident. Bend/Stoop: Frequent bending/stooping while working with seated residents at a table. The worker may bend over at the waist to monitor progress of resident. Crouch: Frequent crouching/squatting is used while working with seated residents at a table. Crouching/squatting may be replaced by sitting or kneeling at the worker's discretion. Twist: Rare twisting occurs during the course of a work day. Kneel: Frequent kneeling is performed while working with seated residents at a table. Kneeling may be replaced by sitting or squatting at the worker's discretion Crawl: Crawling is not a requirement of this position. Handle/Grasp: Constant handling/grasping during the course of the day while documenting and working with hobbies or crafts Fine Manipulation/Fingering: Occasional use of fine finger manipulation during the course of day while assisting residents in the making of crafts. Feeling: Within normal limits in order to feel what is grasped/handled in the course of performing the job tasks. Reach: Occasional reaching above shoulder height to reach items on shelves for various supplies. Frequentlreaching between shoulder and waist height when directing or demonstrating activity. Frequent reaching below waist height during the course of day when assisting with residents. Vision: Normal to correctable vision is constantly required when observing progress of residents.


DOT No.: 076.124-014 Page 4 Talk/Hear: The ability to speak and hear is constantly required during course of day to communicate with residents and other workers. Taste/Smell: Not a requirement of this position. Environmental Factors: Exposure to both outside (10% outdoors) and inside temperature (90% indoors) changes. May be exposed to paints, paint thinner, and other craft type chemicals. May be exposed to infectious disease. Work Environment Access: Access to restroom, parking, and breakroom. Wheelchair accessible. Additional Comments: Note: This description represents the requirements of the job based on observations, discussions with the employer representatives, incumbents and others. On occasion, practicality and feasibility prevent the direct observation and/or gathering of objective, quantifiable data. For this reason, a “best estimate” may have been used.



JOB ANALYSIS

Worker: ______________________

Claim No: ____________________

Job Title: Registered Nurse (RN) - Wellness Nurse – Assisted Living DOT Title: Nurse, General Duty DOT: 075.364-010 GOE: 10.02.01 SVP: 7 Industry: 573 Medical Services Employer: ________________________________ C/O Comprehensive Risk Management


Contact Person: Pamela Kaye Dooner Phone Number: 425.252.7623 Analyst: Stacy Lough, CDMS; Janet Snyder, CDMS Date: December 6, 2011 Job Description: Provides health education, counseling and appropriate nursing services that assist residents in living their lives. (Essential job tasks prioritized below.)

a. In conjunction with the LPN Wellness Nurse, completes resident assessments prior to resident move in, 30 days after resident move in, semiannually and when there is a change in condition.

b. Functions as a health counselor and provides health education for residents. Communicates with resident’s family and Doctors on health-related issues.

c. Based on assessment, develops with the Director, the resident, the resident’s family (when appropriate) and staff a Service Package for each resident.

d. When appropriate, provides direct nursing services and assistance to residents. e. Works closely with the Director to oversee staff development (Resident Service Associate initial and ongoing

training) and supervision. f. In conjunction with the Director, oversees the Quality Assurance Program. Prepares incident reports and

communicates related information to families. g. Monitors and oversees Medication Assistance Program. h. Performs other duties as assigned by management to meet changing job related requirements.

Job Qualifications and Skills: Current Washington State RN License; current necessary training under Washington State WAC regulations; High School diploma and three years of college or comparable education; one year experience; CPR; Food Handler’s Permit (may be obtained after hire).

Claim No: ____________________

Worker: ______________________ Job Analysis: Registered Nurse (RN) - Wellness Nurse – Assisted Living

DOT No: 075.364-010 Page 2

High School Diploma/GED Required: Yes College Degree: N/A WA State Driver’s License: No Special Endorsements: N/A Clean Driving Record/Insurable: No Basic Computer Skills: Yes Speak/read/write English: Yes Keyboard Speed Required: N/A Software (name/version): MS Office and Proprietary Permits/Certifications: CPR, Food Handler’s Permit Type of Computer: PC Computer Operating System (type/version): Windows Licensure: WA State RN Other:

Type of Machines, Tools, Special Equipment Used: Blood pressure cuff, thermometer, stethoscope, gloves, telephone, transfer belt, computer and medical equipment/supplies. Work Schedule: Full time.

PHYSICAL DEMANDS






Stand: OCCASIONAL to FREQUENT standing intermittent with walking is performed for up to two hours at a time while making rounds and checking on residents. Floor surfaces are generally carpet, linoleum, tile or concrete. Walk: OCCASIONAL to FREQUENT walking intermittent with standing is performed for up to two hours at a time while making rounds and checking on residents. Floor surfaces are generally carpet, linoleum, tile or concrete. Sit: OCCASIONAL to FREQUENT sitting for up to two hours while charting activities and medical information by computer and/or hand, inputting payroll and communicating with families. Lift: FREQUENT lift of 0-10 pounds for resident files and individual medical supplies. Lifting up to 25 pounds SELDOM required when stocking medical supplies. Lifting up to 50 pounds is rarely (1-2 time per month) required to assist or transfer residents. The correct use of a transfer belt is required to avoid injury to the resident or nurse. Lifting is performed from floor to shoulder level. Lifting over shoulder level is SELDOM. Carry: FREQUENT carrying up to 10 pounds when carrying resident treatment bag or other items. Carts are used for moving items weighing more than 10 pounds, such as medical equipment and supplies. Push/Pull: OCCASIONAL push/pull cart with medical equipment and supplies requiring up to 10 pounds of force. SELDOM push/pull cart loaded with heavier supplies requiring push/pull force up to 25 pounds. Typically cart rolls easily over concrete walkways, carpeting and tile.

Claim No: ____________________


DOT No: 075.364-010 Page 3

Push wheelchairs on a SELDOM basis. In regards to pushing wheelchairs the ratio is 8:1, so a 150 pound person in a wheelchair that weighs approximately 50 pounds would require 25 pounds of initial push force and then 20 pounds of kinetic force to maintain the pushing. CPR is performed on a SELDOM basis - on average 2-4 times per year. The amount of push force required for CPR chest compression is estimated at 110 pounds maximum. This is a shared force for each upper extremity and the trunk flexion force application would be a shared event, thus each body segment would apply a maximum of approximately 33 pounds of force. CPR is administered until EMS arrives – typically 1-4 minutes. Controls: OCCASIONAL intermittent use of various hand controls with knobs to turn, buttons to push and switches to flip as needed for blood pressure cuff and various other medical equipment. The use of foot controls is SELDOM. Climb: Climbing stairs and ladders is not a requirement of this position. Balance: Balance is within normal limits. Bend/Stoop: FREQUENT bending required when providing treatment to residents, administering medications, taking vital signs and assisting seated residents. Must be able to perform CPR. Crouch, bend, stoop and kneel may often be used interchangeably at employee’s discretion. Crouch: On a rare basis, may need to kneel or crouch to retrieve items at floor level. Crouch, bend, stoop and kneel may often be used interchangeably at employee’s discretion. Twist: OCCASIONAL twisting at the waist may occur when providing medical treatments, assisting in transfer or when applying/changing daily bandages and leg wraps. Kneel: On a rare basis may need to kneel or crouch to retrieve items at floor level. Must be able to perform CPR. Crouch, bend, stoop and kneel may often be used interchangeably at employee’s discretion. Crawl: Crawling is not a requirement of this position. Handle/Grasp: CONSTANT grasping when handling pens/pencils for documenting information into medical charts, when handling paperwork and while using various medical supplies/equipment (stethoscope, thermometer, medications, syringes, etc.). SELDOM forceful grasp used when pushing resident in wheelchair. Grasping for transferring patients occurs on an infrequent monthly basis. Fine Manipulation/Fingering: OCCASIONAL fine finger manipulation while using the computer and telephone and when performing first aid and administering shots. Feeling: Must be able to take vitals (i.e. feel pulse) and must be able to detect temperature differences in skin. Reach: Reaching OCCASIONALLY at all levels from standing and seated positions up to full arm extension when administering to residents who are bedridden and seated, reaching for supplies and using phone. Reaching above shoulder height is not necessary from standing position. Vision: CONSTANT for doing job effectively and correctly. Normal or corrected to normal vision is required. Talk/Hear: Necessary for communicating with others, safety awareness and for taking instructions from physicians and supervisor.

Claim No: ____________________


DOT No: 075.364-010 Page 4

Taste/Smell: Smell is required and necessary to detect dangerous odors when providing wound treatment and performing health assessment. Environmental Factors: Work is performed primarily indoors. Walking between different residential units and the office building will expose worker to weather conditions. Will be exposed to household chemicals, human waste and bodily fluids, infection and viruses and/or sanitation chemicals. May use safety gloves for patient care, sanitation and laundry. Work Environment Access: Wheelchair accessible. Restrooms, parking and break area provided. Additional Comments:


Claim No: ____________________


DOT No: 075.364-010 Page 5

PHYSICIAN:










JOB ANALYSIS

Worker: ______________________

Claim No: ____________________

Job Title: Registered Nurse (RN), Primary Care - Nursing Home DOT Title: Nurse, General Duty DOT: 075.364-010 GOE: 10.02.01 SVP: 7 Industry: 573 Medical Services Employer: __________________________________ C/O Comprehensive Risk Management


Contact Person: Pamela Kaye Dooner Phone Number: 425.252.7623 Analyst: Stacy Lough, CDMS; Janet Snyder, CDMS Date: November 17, 2011 Job Description: (Essential job tasks prioritized) The RN will direct, administer and record the care given to residents in an assigned section of the nursing facility. In this position, the worker's primary responsibilities are:

Documentating and directing the other nursing staff in performing care for the residents. Communicate with family members regarding the progress of the resident. Assist visiting physicians in rounds. Draw blood and obtain fluids to submit for lab work. May be required to complete intravenous infusion/injection. Record and issue appropriate medications. May be required to work with Alzheimer's residents who are not cooperative. Record and monitor all progress of residents and communicate with physicians. May be required to assist in passing out trays to residents in dining area and assist in feeding. Monitor work of other nursing staff in unit to ensure thoroughness. Required to use telephones to communicate with physicians, arrange for transportation for doctor appointments and

contact families. Make rounds to ensure cleanliness and proper care to residents. Coordinate care of residents. Manage all NAC staff in section. Assist staff members according to needs. Follow set protocol in emergency situation.

Claim No: ____________________

Worker: ______________________ Job Analysis: Registered Nurse (RN), Primary Care - Nursing Home

DOT No: 075.364-010 Page 2

Job Qualifications and Skills: Must be licensed as a Registered Nurse or LPN. Ability to speak English. Ability to perform CPR preferred. High School Diploma/GED Required: Yes College Degree: N/A WA State Driver’s License: No Special Endorsements: N/A Clean Driving Record/Insurable: No Basic Computer Skills: Yes Speak/read/write English: Yes Keyboard Speed Required: N/A Software (name/version): MS Office & Proprietary Permits/Certifications: CPR, Food Handler’s Permit Type of Computer: PC Computer Operating System (type/version): Windows Licensure: WA State RN Other:

Type of Machines, Tools, Special Equipment Used: Computer, telephone, gowns, goggles, gloves, masks, Accucheck (Blood Sugar), scale, blood pressure cuff, bladder scanner, pulse oximeter, thermometer, IV pumps, portable oxygen and various first aid supplies and equipment. Work Schedule: Full time.

PHYSICAL DEMANDS





Strength: Medium (M), according to the Classification of Jobs (COJ), involves the ability to exert 20 to 50 pounds of force occasionally, 10 to 25 pounds of force frequently, and greater than 10 pounds of force constantly, to move objects. Stand: OCCASIONAL standing intermittent with walking is performed for up to two hours at a time while making rounds and checking on residents. Employer states static stand up to 2 minutes at one time when administering treatments. Twice per week static standing is required up to 45 minutes for longer treatments. Floor surfaces are generally carpet, linoleum, tile or concrete. Walk: FREQUENT walking is performed intermittent with standing for approximately three to four hours per day on carpet and vinyl flooring. Sit: OCCASIONAL while charting activities and medical information by computer and/or hand, phoning doctors, taking orders and communicating with families. Lift: FREQUENT lift up to10 pounds for resident files and supplies. Lifting 10-25 pounds OCCASIONALLY required for medical supplies/equipment. SELDOM lifting up to 50 pounds to assist and transfer residents with transfer belt. The correct use of a transfer belt is required to avoid injury to the resident or nurse. Vera Lift and Vander Lifts are used to minimize weight. Lifting primarily performed from floor to shoulder level. Lifting over shoulder level is SELDOM.

Claim No: ____________________


DOT No: 075.364-010 Page 3

Carry: FREQUENT up to 5 pounds. OCCASIONAL 5-10 pounds to move items from one location in the facility to another. Carts are available for heavier supplies and/or equipment. Push/Pull: OCCASIONAL push/pull cart with medical equipment and supplies requiring up to 10 pounds of force. SELDOM push/pull cart loaded with heavier supplies requiring push/pull force up to 25 pounds. Typically cart rolls easily over concrete walkways, carpeting and tile. Push wheelchairs on an OCCASIONAL basis. In regards to pushing wheelchairs the ratio is 8:1, so a 150 pound person in a wheelchair that weighs approximately 50 pounds would require 25 pounds of initial push force and then 20 pounds of kinetic force to maintain the pushing. Each employee performs CPR on a SELDOM basis. CPR is needed 1-2 times per week throughout the facility and multiple employees perform this function. The amount of push force required for CPR chest compression is estimated at 110 pounds maximum. This is a shared force for each upper extremity and the trunk flexion force application would be a shared event, thus each body segment would apply a maximum of approximately 33 pounds of force. CPR is administered until EMS arrives – typically 1-4 minutes. Controls: FREQUENT use of various hand controls with knobs to turn, buttons to push and switches to flip as needed for blood pressure cuff and various other medical equipment. The use of foot controls may be required for hydraulic beds, wheelchair brakes, etc. Climb: Climbing stairs and ladders is not required – elevators and ramps are available. Balance: Balance is within normal limits. Bend/Stoop: OCCASSIONAL bending may occur when providing treatment to residents, administering medications, taking vital signs and assisting seated residents, etc. Must be able to perform CPR. Crouch, bend, stoop and kneel may often be used interchangeably at employee’s discretion. Crouch: Not a required physical demand of this position. Twist: OCCASIONAL twisting may occur while providing patient care. Kneel: Must be able to perform CPR. Crawl: Not a required physical demand of this position. Handle/Grasp: FREQUENT handling paperwork, pens/pencils, telephone and various medical supplies/equipment (i.e. stethoscope, thermometer, medications, syringes, etc). Fine Manipulation/Fingering: OCCASIONAL fine finger manipulation while using the computer keyboard, writing, and when performing first aid, administering shots and medications. Feeling: OCCASIONAL to assess residents’ vitals (i.e. feel pulse and skin temperature). Reach: Above shoulder level – OCCASIONAL when attending patients with tubes and IVs and to obtain supplies on shelves. Waist to shoulder level - FREQUENT while documenting charts, drawing blood and providing care to residents. Below waist level– OCCASIONAL to obtain clerical supplies or charting information in drawers.

Claim No: ____________________


DOT No: 075.364-010 Page 4

Vision: Normal or corrected to normal required. Must be able to read labels, doctor’s instructions, medication orders, charts and medical history. Talk/Hear: Necessary for safety awareness and for communicating and taking instructions from physicians, labs, pharmacists, families and supervisor. Ability to read, write, and speak English. Taste/Smell: Smell is required and necessary to detect dangerous odors, provide wound treatment and to perform health assessment/diagnosis. Environmental Factors: Work is performed primarily indoors. Will be exposed to household and hospital chemicals, human waste and bodily fluids, infection and viruses and/or sanitation chemicals. May use safety gloves for patient care, sanitation and laundry. May use mask, goggles and gowns. Possible exposure to needle pricks. Work Environment Access: Wheelchair accessible. Restrooms, parking and break area provided. Additional Comments:


Claim No: ____________________


DOT No: 075.364-010 Page 5

PHYSICIAN:










JOB ANALYSIS

Worker: _____________________

Claim No: ___________________

Job Title: Residential Service Associate (RSA) -Assisted Living DOT Title: Nurse Assistant DOT: 355.674-014 GOE: 10.03.02 SVP: 4 Industry: 573 Medical Services Employer: ________________________________ C/O Comprehensive Risk Management


Contact Person: Pamela Kaye Dooner Phone Number: 425.252.7623 Analyst: Stacy Lough, CDMS; Janet Snyder, CDMS Date: December 6, 2011 Job Description: Responsible for providing services that will support and assist residents in activities of daily living. (Essential job tasks prioritized below.)

a. Based on resident-negotiated service agreements, provides assistance with medication, dressing, grooming, showering, dining, toileting, incontinence management, transfers and mobility/ambulation.

b. Prepares, serves and cleans up breakfast. Completes final meal preparation, meal set up, meal serving and meal clean up for lunch and dinner.

c. Occasionally provides extra housekeeping and laundry services for residents based on their negotiated service agreement. Strips beds, washes sheets, towels once per week; cleans kitchen and mattress pads as needed.

d. Provides housekeeping services for common areas (vacuuming, wipe down/sanitation, dishwashing, etc). e. Helps Activity Director and/or assists residents to group and individual activities designed to meet their needs,

interests and capabilities. f. In cardiac/emergency situations first calls 911, then Wellness Nurse on staff. g. Reports to Wellness Nurse and works under little supervision. Performs other duties as assigned to meet

changing job related requirements. Job Qualifications and Skills: High School diploma or equivalent, and ability to effectively read, write, speak and understand English. Must meet all training requirement per current state WAC regulations. First Aid, CPR within 30 days of hire; mental health and dementia specialty training within 120 days of hire; Food Handler’s Permit. Prior geriatric care giving desired.

Claim No: ____________________

Worker: ______________________ Job Analysis: Residential Service Associate (RSA) - Assisted Living

DOT No: 355.674-014 Page 2

High School Diploma/GED Required: Yes College Degree: N/A WA State Driver’s License: No Special Endorsements: N/A Clean Driving Record/Insurable: N/A Basic Computer Skills: N/A Speak/read/write English: Yes Keyboard Speed Required: N/A Software (name/version): N/A Permits/Certifications: Food Handler’s Permit; First Aid

and CPR Type of Computer: N/A Computer Operating System (type/version): N/A Licensure: per WA State requirements Other:

Type of Machines, Tools, Special Equipment Used: Cart, blood pressure cuff, basic medical supplies, gloves, scale, thermometer; transfer belt. Work Schedule: Full time.

PHYSICAL DEMANDS






Stand: FREQUENT standing intermittent with walking is performed for up to two hours at a time while making rounds and checking on residents. Floor surfaces are generally carpet, linoleum, tile or concrete. Walk: FREQUENT walking intermittent with standing is performed for up to two hours at a time while making rounds and checking on residents. Floor surfaces are generally carpet, linoleum, tile or concrete. Sit: SELDOM sitting while charting activities and when talking with residents. Lift: Waist to Shoulder Level CONSTANT - up to 10 pounds of residents’ personal items (i.e. clothing, food items, medical charts and supplies). OCCASIONAL - 11-20 pounds of soiled bed linens, resident belongings, large size containers from food and supply delivery carts and when assisting a resident in bathing or dressing. SELDOM – 20 pounds to 50 pounds. Employer states lifting up to 50 pounds when assisting or transferring a resident - occurs on average once per week. Below waist and above shoulder Level SELDOM – up to 5 pounds for supplies and dishes located at lower and higher levels. Carry: CONSTANT carrying up to 10 pounds of resident’s personal items (i.e. laundered clothing, food items, medical charts and supplies). OCCASIONALLY carrying 11-20 pounds when transporting laundry baskets and soiled bed linens to a utility area and when moving supplies. Carts are used for moving items weighing more than 20 pounds.

Claim No: ____________________


DOT No: 355.674-014 Page 3

Push/Pull: OCCASIONAL to FREQUENT push/pull cart with supplies requiring up to 10 pounds of force. SELDOM push/pull cart loaded with heavier supplies requiring push/pull force up to 25 pounds. Typically cart rolls easily over concrete walkways, carpeting and tile. Push wheelchairs on an OCCASIONAL to FREQUENT basis. In regards to pushing wheelchairs the ratio is 8:1, so a 150 pound person in a wheelchair that weighs approximately 50 pounds would require 25 pounds of initial push force and then 20 pounds of kinetic force to maintain the pushing. CPR is performed on a SELDOM basis - on average 2-4 times per year. The amount of push force required for CPR chest compression is estimated at 110 pounds maximum. This is a shared force for each upper extremity and the trunk flexion force application would be a shared event, thus each body segment would apply a maximum of approximately 33 pounds of force. CPR is administered until EMS arrives – typically 1-4 minutes. Controls: OCCASIONAL intermittent use of various hand controls with knobs to turn, buttons to push and switches to flip as needed for laundry, kitchen and vitals. The use of foot controls is OCCASIONAL (i.e. brakes on wheelchairs, etc). Climb: Climbing stairs and ladders is not a requirement of this position. OCCASIONAL use of step stool for reaching supplies at higher levels. Balance: Balance is within normal limits. Bend/Stoop: FREQUENT bending at waist and neck while assisting resident in bathing, loading/unloading dish washer, loading/unloading laundry washer/drying and when performing light housework. Must able to perform CPR. Crouch: OCCASIONAL crouching/squatting may occur while bathing and dressing a resident or using the washer and dryer. Crouch, bend, stoop and kneel may often be used interchangeably at employee’s discretion. Twist: OCCASIONAL twisting at the waist while preparing food, vacuuming, doing laundry, transferring resident or assisting in daily living. Kneel: On a rare basis may need to kneel when retrieve items at floor level or dressing resident. Must be able to perform CPR. Crouch, bend, stoop and kneel may often be used interchangeably at employee’s discretion. Crawl: Crawling is not a requirement of this position. Handle/Grasp: CONSTANT grasping when handling residents’ personal items, eating utensils, kitchen equipment, household appliances and when preparing meals and doing laundry. OCCASIONAL to FREQUENT forceful grasp used when pushing resident in wheelchair. Grasping for transferring patients occurs on an infrequent weekly basis. Fine Manipulation/Fingering: OCCASIONAL fine finger manipulation occurs while documenting residents’ medical charts, administering daily medications and as needed for buttons and laces when dressing. Feeling: Within normal limits for checking food and plate temperatures for safety. Reach: Occurs at all levels up to full arm extension. Above shoulder level – OCCASIONAL when reaching for medical records, dishes and supplies located on shelves. Waist to shoulder level – FREQUENT when assisting residents in changing bed linens, serving food, working in the kitchen, doing laundry and cleaning.

Claim No: ____________________


DOT No: 355.674-014 Page 4

Below waist level – FREQUENT when assisting residents with dressing and bathing, performing kitchen duties, doing laundry and reaching items located in dishwasher and oven. Vision: CONSTANT. Normal or corrected to normal vision is necessary for doing job effectively and correctly. Talk/Hear: The ability to speak and hear is necessary for communicating with residents and other aids and for taking instructions from Wellness Nurse and requests from residents. Taste/Smell: Smell is required and necessary to detect safety and sanitary odors. Environmental Factors: Work is performed primarily indoors. Walking between different residential units and the office building will expose worker to weather conditions. Will be exposed to household chemicals, human waste and bodily fluids, infection and viruses and/or sanitation chemicals. May use safety gloves for patient care, sanitation and laundry. Work Environment Access: Wheelchair accessible. Restrooms, parking and break area available. Additional Comments:


Claim No: ____________________


DOT No: 355.674-014 Page 5

PHYSICIAN:










(253) 661-5550 (206) 203-0057 [fax]


(253) 661-5550 (360) 786-8045 [fax]

JOB ANALYSIS

Worker: ___________________ Claim No: ___________________

Job Title: Security Guard DOT: 372.667-034 DOT Title: Security Guard GOE: 04.02.02 SVP: 3 Location: __________________________________

C/O ComprehensiveRisk Management ATTN: Pamela Kaye Dooner 1520 Broadway, Suite 201 Everett, WA 98201






Claim No: __________________ Worker: __________________ Job Analysis - Security Guard

DOT No.: 372.667-034 Page 2 Job Description: (Essential job tasks prioritized below.) Protects facility property from damage or loss from fire, robbery, and other hazards. Checks various doors to ensure locked through building complex. May be required to turn on outside and inside lights. Required to keep a log of all incidents during the course of shift. On a rare occasion this employee may be required to chase after trespassers but can call upon the assistance of the police if this should occur. Although this is a somewhat sedentary position with very light lifting, the employee may be required to restrain a trespasser on occasion. A hand-held radio is usually available to contact help if necessary. Competancies required to perform this job include: Repetitive or Short Cycle Work: Work situations where performing a few routine and uninvolved tasks over and over again according to set procedures, sequence, or pace with little opportunity for diversion or interruption. Interaction with people is included when it is routine, continual or prescribed. Dealing with People: Work situations that involve interpersonal relationships in a job setting beyond giving and receiving work instructions. Performing Under Stress: Work situations that involve coping with circumstances dangerous to the worker or others. Job Qualifications: Types of Machines, Tools, Special Equipment Used: Hand-held radio and telephone. Materials, products, subject matter, services: 951, Protective Services Industry Designation: 138, Any Industry Work Schedule:

PHYSICAL DEMANDS Strength Level: Light to Medium Stand: Frequent standing, occurring for up to four hours at a time on surfaces of carpeting, linoleum, tile or concrete. Walk: Frequent walking, on a flat surface of carpet, tile, or concrete. Sit: Rare sitting, usually only while on breaks or when driving a vehicle. Lift: Frequent lifting of a hand-held radio weighing approximately 3-pounds. Occasionally pick up litter on the grounds, weighing less than one pound. Rarely lift and deliver parcels to residents, which do not exceed 20-pounds. May rarely need to restrain a trespasser. Usually, the worker will call for assistance from police.


DOT No.: 372.667-034 Page 3 Carry: Constantly carrying a 3-pound hand-held radio. Not required to carry anything weighing over 20 pounds. Push: Occasionally push/pull doors or desk drawer. Rare push/pull in the process of apprehending a tresspasser if the individual is caught and restrained. Pull: See "push" Controls: Intermittently use hand controls such as push button, dial turn, flipped switch, etc. Intermitten use of hand and foot controls to operate a vehicle as directed by the employer. Climb: Occasionally may be required to climb stairs up several flights. Elevators are available. Balance: Within normal limits to stand/walk/sit to perform the job tasks as described. Bend/Stoop: Occasional bending/stooping while patrolling/making checks of the facility. Crouch: Rare squatting/crouching will be performed. Twist: Rare twisting will be performed. Kneel: Rare kneeling will be performed. The worker may bend or stoop instead of kneeling. Crawl: Crawling is not a requirement of this position. Handle/Grasp: Frequently required to handle a radio, grasp doors/door knobs, etc.. Fine Manipulation/Fingering: Rarely may be required to use the telephone, operated with fine finger manipulation.. Feeling: Within normal limits. Reach: Occasional reaching between waist and shoulder height when checking doors to ensure they are locked. Rare reaching below waist or overhead. Vision: Necessary for doing the job effectively and correctly. Talk/Hear: Necessary for communicating and taking instruction from others. Taste/Smell: The sense of smell is needed to assess the odor of smoke/fire. Environmental Factors: Exposure to heat and cold outdoors, although the position is approximatley 98% indoor and 2% outdoor. Work Environment Access: Access to parking.



(253) 661-5550 (206) 203-0057 [fax]


(253) 661-5550 (360) 786-8045 [fax]

JOB ANALYSIS

Worker: ___________________ Claim No: ___________________

Job Title: Stock Clerk DOT: 222.387-058 DOT Title: Stock Clerk GOE: 05.09.01 SVP: 4 Location: ________________________________

C/O Comrehensive Risk Management ATTN: Pamela Kaye Dooner 1520 Broadway, Suite 201 Everett, WA 98201






Claim No: ___________________ Worker: ___________________ Job Analysis - Stock Clerk

DOT No.: 222.387-058 Page 2 Job Description: (Essential job tasks prioritized below.) Receive and verify food coming into the facility. Record information for reordering. May be required to rotate stock to ensure timely food use. Store various food in refrigerator or dry storage room. Count and verify incoming food to ensure that the order is correct. Take inventory of available stock and reorder according to facility needs or menu created by dietitian. May be required to sweep and mop storage areas. The worker may be required to assist elsewhere within the facility when not performing stock clerk duties; such as assist in the kitchen, dishwashing or preparing meals. May also contribute to planning the meals with the director of Dietary Services. This position is available only on a part time basis. Most employees are also required to perform other tasks other than stock room work. Compatencies required to perform the job include: Attaining Precise Set Limits, Tolerances, and Standards: Work situations that involve adhering to and achieving exact levels of performance, using precision measuring instruments, tools, and machines to attain precise dimensions. Preparing exact verbal and numerical records. Complying with precise instruments and specifications for materials, methods, procedures, and techniques to attain specified standards. Variety Of Duties: Work situations that involve frequent changes of tasks using different techniques, procedures, or degrees of attentiveness without loss of efficiency or composure. Making Judgments and Decisions: Work situations that involve solving problems, making evaluations, or reaching conclusions based on subjective or objective criteria, such as the five senses, knowledge, past experiences, or quantifiable or factual data Job Qualifications: Types of Machines, Tools, Special Equipment Used: Hand truck Materials, products, subject matter, services: 898, Production Services Industry Designation: 249, Clerical & Kindred Work Schedule:

PHYSICAL DEMANDS Strength Level: Medium Stand: Occasional to Frequent standing, for three to four hours out of an eight hour work day on primarily linoleum or tile floor surfaces. Walk: Occasional to Frequent walking, for three to four hours out of an eight hour work day on primarily linoleum or tile floor surfaces.


DOT No.: 222.387-058 Page 3 Sit: Occasional sitting is performed for one to two hour during a work day. Lift: Occasional lifting of various canned products weighing up to three pounds. Occasional lifting of boxes filled with various food stuffs weighing up to 15 pounds. Occasional lifting of 30 to 40 pound bags of potatoes. No lifting over 50 pounds. Carry: Occasional carrying various canned food individually or in boxes (3-15 pounds) within the storage area a distance of approximately 10 to 15 feet. Rare carrying of 50 pound bags of potatoes. This can be modified by using a hand truck. Push: Occasional push/pull with minimal force when sweeping or mopping storage areas. Pull: See “push” Controls: The use of hand or foot controls is not a requirement of this position. Climb: Occasionally climb a step ladder to reach higher shelves in stock room. Balance: Within normal limits to maintain balance on the step-ladder, while standing, while walking, etc. Bend/Stoop: Frequent bending/stooping occurs while taking inventory or stocking food on lower shelves. Crouch: Frequent crouching/squatting occurs while taking inventory of food on lower shelves. Intermittent with bending. Twist: Occasional twisting while sweeping and mopping the storage areas or when rotating stock. Kneel: Frequent kneeling occurs while taking inventory of food on lower shelves. Bending and crouching may be used in place of kneeling at the worker’s discretion. Crawl: Crawling is not a requirement of this position. Handle/Grasp: Constant handling of various food items; i.e., boxes and cans of various prepared food substances. Frequently to Constantly grasp canned food items, pen/pencil, and paper for inventory. Fine Manipulation/Fingering: Not required in this position, however, some facilities may implement the use of a computer for their inventory. Feeling: Within normal limits to perform the handling/grasping needed to perform this position. Reach: Frequently reaching above shoulder height when checking inventory on higher shelves or placing received stock onto upper shelves. Frequently reaching at and below shoulder height when counting stock.


DOT No.: 222.387-058 Page 4 Vision: Necessary for counting and ensuring correctiveness of paperwork. Talk/Hear: Necessary for communicating with others and taking instructions from others. Taste/Smell: Not a requirement of this position. Environmental Factors: May be exposed to some cleaning solutions. The position is performed indoors. Work Environment Access: Access to parking, restroom, breakroon. Additional Comments: Note: This description represents the requirements of the job based on observations, discussions with the employer representatives, incumbents and others. On occasion, practicality and feasibility prevent the direct observation and/or gathering of objective, quantifiable data. For this reason, a “best estimate” may have been used.



(253) 661-5550 (206) 203-0057 [fax]


(253) 661-5550 (360) 786-8045 [fax]

JOB ANALYSIS

Worker: ___________________ Claim No: ___________________

Job Title: Transitional Work Options DOT: DOT Title: GOE: SVP: Location: ___________________________________

c/o Comprehensive Risk Management ATTN: Pamela Kaye Dooner 1520 Broadway, Suite 201 Everett, WA 98201






Claim No: _________________ Worker: _________________ Job Analysis – Transitional Work Options

DOT No.: _________________ Page 2 SUMMARY OF CRITICAL PHYSICAL DEMANDS AND JOB DUTIES: FEEDING PATIENTS: In this transitional option, the employee will assist with placing bibs on patients before meals, serving trays in the dining room and pouring liquids, cutting meat and other foods, pouring coffee, tea and other drinks, feeding patients after they are positioned, recording the input and output charts, returning trays to cart, assist with brushing teeth, and pick up water pitchers and redistribute with ice and water after the kitchen has cleaned the pitchers. Physically this job requires intermittent standing and walking predominately, for two hours at a time up to eight hours out of an eight hour day. There is intermittent sitting that can be performed while doing charting and while assisting with some feeding activities. Lifting would be up to a maximum of 10 pounds. There would be frequent reaching, grasping, and handling in this position. There would be occasional bending and very rare kneeling or crouching. The majority of reaching would be at waist to chest height, although reaching would be performed at all ranges of motion. There would be some intermittent pushing or pulling of food trays requiring minimal force. PHYSICIAN REVIEW: APPROVE______ DISSAPPROVE ______ DIRECT PATIENT CARE-PERSONAL HYGIENE ASSISTANCE: This transitional option consists of assisting with washing faces and hands for meals, sorting socks, performing minor mending, shampooing hair, assisting with brushing teeth, trimming finger and toe nails, combing hair, shaving male patients, assisting with putting away clothing, cleaning closets, helping with activities, and delivering water pitchers. The majority of the activities are performed while in a standing and walking position, although there may be intermittent sitting performed while doing mending, sorting socks, or other miscellaneous activities. Lifting would be up to a maximum of 10 pounds, with carrying only necessary for short distances. There would be occasional bending and twisting performed, and rare kneeling or squatting. There would be occasional pushing and pulling consisting of a water cart, with frequent handling, grasping, fingering and reaching at all ranges of motion. PHYSICIAN REVIEW: APPROVE______ DISAPPROVE______ NON DIRECT PATIENT CARE ACTIVITIES LEVEL I: This position consists of performing activities such as labeling beds and drawers, folding laundry, dusting, clearing dishes, adjusting bed heights, marking clothing and belongings, organizing drawers, delivering mail, taking vital signs, taking pictures of new admissions, assisting patients with hand work activities, completing flow charts, wiping off the microwave and checking the showers for wash clothes and soap. The majority of these activities are performed while standing and walking, although there may be very intermittent sitting performed. Lifting ranges up to 10 pounds, with carrying performed up to 10 pounds for 50 to 100 feet. There is occasional pushing and pulling, and frequent handling, and grasping required. There is occasional bending, kneeling or crouching. Reaching is performed at all ranges of motion. PHYSICIAN REVIEW: APPROVE______ DISAPPROVE______


DOT No.: _________________ Page 3 NON DIRECT PATIENT CARE ACTIVITIES LEVEL II: These types of activities consist of transporting soiled linen to the holding area, washing walls, washing windows and pictures, cleaning up after meals, cleaning toilet seats, cleaning urine and other accidents from the floor, defrosting and cleaning the refrigerator, assisting with washing the body after death and washing the wheelchairs or shower chairs. These activities require standing and frequent bending, and occasional kneeling, or crouching. There may be frequent pushing and pulling in this position. There is constant reaching at all ranges of motion, and frequent grasping and handling. Lifting ranges up to 25 pounds. PHYSICIAN REVIEW: APPROVE______ DISAPPROVE______ OFFICE CLERK: In this transitional position the worker would assist with greeting visitors, answering the telephone, taking messages, performing filing, entering information into the computer, and performing copying as needed. This position is predominately performed in a seated position, although there would also be intermittent standing and walking around the office area. Lifting would be a maximum of 10 pounds. There would be occasional pushing and pulling of desk drawers and file drawers requiring minimal force. There would be rare kneeling, crouching, or bending required in this position. Reaching would be predominately at wait to chest height, with frequent grasping, handling, fingering and feeling. PHYSICIAN REVIEW: APPROVE______ DISAPPROVE______ TRANSPORTING PATIENTS AND EQUIPMENT: Push residents in wheelchairs around facility on linoleum floors, push carts with meal trays, push laundry carts around facility. These activities require pushing or pulling with 20-40 lbs. force, standing & walking, and occasional bending & kneeling or crouching. PHYSICIAN REVIEW: APPROVE______ DISAPPROVE______


DOT No.: _________________ Page 4 Work Schedule: Will be variable depending on specific physician recommendations. Physician comments (please document how many hours per day the worker can work and any

physical restrictions): Physician Date



(253) 661-5550 (206) 203-0057 [fax]


(253) 661-5550 (360) 786-8045 [fax]

JOB ANALYSIS

Worker: ____________________ Claim No: ____________________

Job Title: Wait Person DOT: 311.477-030 DOT Title: Waiter/Waitress, Informal GOE: 09.04.01 SVP: 3 Location: _________________________________







Job Description: (Essential job tasks prioritized below.)

Claim No: ____________________ Worker: ____________________ Job Analysis - Wait Person

DOT No.: 311.477-030 Page 2 Waitpersons are responsible for greeting customers, taking orders, serving food and drinks, and processing cash, checks, and credit cards for payment. Also ensures cleanliness of assigned section, utensils, glasses,, and general area. Picks up any & all debris on floor, and promptly removes empty glassware & dishes from tables. Uses suggestive selling techniques to advise customers on menu selections, fresh offerings, and deserts, etc. Competencies required to perform the job include: Repetitive or Short Cycle Work: Work situations where performing a few routine and uninvolved tasks over and over again according to set procedures, sequence, or pace with little opportunity for diversion or interruption. Interaction with people is included when it is routine, continual or prescribed. Dealing with People: Work situations that involve interpersonal relationships in a job setting beyond giving and receiving work instructions. Job Qualifications: Must have an excellent customer service orientation, and pleasant and cheerful disposition. Must be reliable, and have good accuracy & attention to detail regarding menu items and ordering. Types of Machines, Tools, Special Equipment Used: Tray, cash register, credit card processing equipment, tray stands, dining utensils, etc. Materials, products, subject matter, services: 903, Meals Service Industry Designation: 453, Hotel & Restaurant Work Schedule: Variable schedule, 25 to 40 hours per week. Schedule determined by the supervisor.

PHYSICAL DEMANDS Strength Level: Light Stand: Frequent, standing and walking are performed for two to three hours at a time on carpeted and tile surfaces, up to 7 hours total. Maximum walking distance at one time (from food service area to dining area) is 100 - 150 feet.; the actual distance will vary depending upon the restaurant, although walking is generally nearly consistent. Walk: See "stand" Sit: Sitting is ordinarily only performed during breaks and at lunch, for 10 - 30 minutes at a time.


DOT No.: 311.477-030 Page 3 Lift: Frequent lifting and carrying of 1 - 10 lbs (plates, glasses, water, drinks), with Occasional lifting and carrying of trays of food/drinks weighing up to 25 - 30 lbs. Trays are lifted from counter height (40"), carried while supported on the hand and shoulder, and placed at table height (29"). Actual specifics of the lifting and carrying requirements will depend upon the dishes and arrangement of the individual restaurant. Carry: See "lift" Push: Occasional pushing or pulling of tables, chairs, etc. may be performed while providing customer service. Pull: See "push" Controls: Intermittent use of hand controls of the cash register and credit card machine, using push buttons. Climb: Climbing stairs will vary, depending upon the actual restaurant chosen. Climbing ladders is not required. Balance: Within normal limites to perform the job tasks. Bend/Stoop: Frequent bending is performed while serving food and drinks, and clearing tables. Crouch: Rare crouching/squatting would be performed, ordinarily when picking up debris from the floor. Twist: Frequent twisting is performed while serving food and drinks and setting up trays, etc. Kneel: Rare kneeling when picking up debris from the floor, at the discretion of the worker. Crawl: Crawling is not a requirement of this position. Handle/Grasp: Repetitive grasping and handling is required to serve customers food and drinks. Fine Manipulation/Fingering: Finger pinch and fine finger manipulation is utilized on an occasional basis. Waitpersons perform cash & credit card transactions, requiring intermittent keying. Feeling: Within normal limits in order to perform the various job tasks with gripping, handling hot food, etc. Reach: Constant reaching at waist to chest level, with Occasional reaching overhead and to ground level to obtain supplies, and to pick up debris on the floor. Vision: Must be able to see to navigate around the dining room to serve food.


DOT No.: 311.477-030 Page 4 Talk/Hear: Must be able to communicate clearly with customer and supervisors in a persuasive manner. Taste/Smell: Not required, although helpful to advise customers of the various tastes of prepared dishes. Environmental Factors: The restaurant has temperature control, so temperatures are moderate. May use cleaning agents. May be exposed to illness from residents at the facility. Work Environment Access: Access to restroom, break room and parking. Additional Comments: Note: This description represents the requirements of the job based on observations, discussions with the employer representatives, incumbents and others. On occasion, practicality and feasibility prevent the direct observation and/or gathering of objective, quantifiable data. For this reason, a “best estimate” may have been used.



(253) 661-5550 (206) 203-0057 [fax]


(253) 661-5550 (360) 786-8045 [fax]

JOB ANALYSIS

Worker:_____________

Claim No.: ___________

Job Title: Nurses Aid Certified (NAC) DOT Title: Nurse Assistant DOT: 355.674-014 GOE: 10.03.02 SVP: 4 Location: _________________________________


Contact Person: Robin Martin Administrator Phone Number: 425.672.4673 Analyst: Kristi Schmidt, MA, CRC Date: 2/21/06 Job Description: (Essential job tasks prioritized below.) Assist residents who are lucid, ambulatory and non-combative with activities of daily living. Assist residents in bathing, dressing/undressing, and personal grooming. Assist ambulatory residents in and out of bed by assisting them with lifting their feet only. Dispense pre-dosed medications to residents. Take vital signs such as blood pressure and temperature and record information. Assist residents to dining areas for meals and assist in basic meal preparation and clean-up. Assists with changing bed sheets, laundry, storage of clothes/linens, and light dusting/vacuuming. Must be able to bend to perform CPR. Job Qualifications: Nurse assistant certification and previous experience. Types of Machines, Tools, Special Equipment Used: Blood pressure cuff, thermometer, and grooming implements. Industry Designation: 573 Medical Services.

Claim No: ____________ Worker:____________________

Nurses Aid Certified (NAC) DOT No.: 355.674-014

Page 2 Work Schedule: Full-time, shifts vary between early morning, afternoon, evening, and overnight.

PHYSICAL DEMANDS

Seldom: 1-10% of the time N/A: Not Applicable

Occasional: 10-30% of the time WNL: Within Normal Limits

Frequent: 30%-70% of the time * Denotes Estimates

Constant: Over 70% of the time


Strength Level: Light to Medium Please note that the strength level for this position has been modified to the Light to Medium level, per the employer's description of the position. Per the DOT and the information from the Enhanced Job Analyzer, the position is typically reported to be in the Medium physical demand level; however, the actual physical demands required can vary from employer to employer, and as a result the physical demand level for this position has been modified to the Light to Medium level (lower level of medium). Stand: Employee will frequently stand, intermittent with walking for 75% of the shift, up to 6 hours per day. May statically stand up to 10 minutes at a time on carpeted, vinyl and tile floors. Walk: Employee will occasionally walk, intermittent with standing for 75% of the shift, up to 6 hours per day. May walk up to 10 minutes at a time on carpeted, vinyl and tile floors. Please note that the greater labor market reports that the employee will frequently walk, interspersed with frequent standing. Sit: Employee occasionally sits, intermittent with stand/walk for 25% of the workday, up to 2 hrs per day while completing records and when charting. A typical office chair issued and the employee does not typically sit for more than 30 minutes at a time. Lift: Employee occasionally lifts items weighing up to 20 pounds, such as clothing, food, medical charts, supplies, grooming implements, linens, medications and equipment. Employee frequently lifts items weighing up to 10 pounds. All residents in this facility are ambulatory and patient transfers are not required. If a resident falls, employees contact 911 for assistance. Employees are not permitted to move patients. Employee may assist patients in getting in/out of bed, which will not require lifting more than 20 pounds Carry: Employee may occasionally carry items weighing up to 20 pounds and frequently carry items weighing up to 10 pounds. Please note that the greater labor market notes that the employee may occasionally lift/carry items that weigh up to 30 lbs. Push: Employee may occasionally push or pull a wheelchair or a small cart over a smooth floor (not necessarily on a daily basis). Residents are typically ambulatory. Must be able to perform CPR. Pull: Please see "Push".

Claim No: ____________ Worker:____________________


Page 3 Controls: Employee may operate hand controls on office equipment or household/cleaning type equipment. Climb: Employee is not required to climb stairs or ladders. Balance: Within normal limits, employee does not work at heights. Bend/Stoop: Employee occasionally bends at waist when assisting residents with daily living tasks, performing light housekeeping duties or when preparing food. Employee must be able to bend to perform CPR. Crouch: Employee occasionally crouches when assisting residents with daily living tasks. Twist: Employee occasionally twists at the waist while assisting residents with daily living tasks. Kneel: Employee may kneel to reduce crouching and bending. Must be able to kneel in order to perform CPR. Crawl: Employee is not required to crawl. Handle/Grasp: Employee will frequently to constantly (approximately 65% of the time) grasp and handle grooming implements, blood pressure cuff, thermometer, clothing, medications and other related items. Handle/grasp activities are non-repetitive and intermittent. Worker can perform many duties with one hand. Also require hand usage to perform CPR, if needed. Fine Manipulation/Fingering: Employee occasionally (approximately 30% of the time) and intermittently uses fine finger manipulation when working with residents and recording/charting information. Feeling: Employee must be able to feel patient's pulse when taking vitals. Reach: Employee frequently reaches (non-weight bearing) with ¾ to full arm extension in all directions when assisting residents in daily living tasks. Overhead reaching is occasional. Vision: Employee must have good vision to perform job tasks. Talk/Hear: Good speaking and listening abilities are necessary, and the employee must be able to effectively communicate in the English Language with co-workers and residents. Taste/Smell: Employee should be able to smell to discern if a resident is incontinent or to detect smoke, etc. Environmental Factors: Employee works indoors, in a climate controlled facility most of the workday. Employee will rarely go outside. Employee is not subject to whole body or upper extremity vibration. Employee may be exposed to household chemicals, human waste, infection and viruses and/or sanitation chemicals. Rubber gloves, masks, goggles and gowns are usually available. Work Environment Access: Facility is accessible to individuals with disabilities. Additional Comments: Worker must be able to perform CPR.

Claim No: ____________ Worker:____________________


Page 4 Please review and respond to this job analysis based on the physical demands required by the individual contact as well as by the greater labor market information. In addition, please note any modifications that may be required. Note: The information for this job analysis was gathered during a telephone interview. This description represents the requirements of the job based on observations, discussions with the employer representatives, incumbents and others. On occasion, practicality and feasibility prevent the direct observation and/or gathering of objective, quantifiable data. For this reason, a “best estimate” may have been used.

Claim No: ____________ Worker:____________________


Page 5 PHYSICIAN:

I agree that the above name injured worker can perform the physical activities described in this job analysis and can return to work. State date worker is released to return to work if different from today’s date .

I agree the injured worker can perform the described job but only with modifications (describe in comments section). Modifications are needed on a permanent or temporary basis.

The above-named injured worker temporarily cannot perform this job based on the following physical limitations:

Anticipated release date:

Treatment plan:

The above named injured worker is permanently restricted from performing the physical activities

described in this job analysis based on the following physical limitations (state objective medical findings): Comments: Attending Physician Date

group retrospective rating program job analysis...

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