DEPARTMENT OF HOMELAND SECURITY 

FEDERAL LAW ENFORCEMENT TRAINING CENTERS 

REASONABLE ACCOMMODATION JOB ANALYSIS QUESTIONNAIRE 

PART I - BACKGROUND INFORMATION 

Name of Employee: Position Description #: 

Position Title: Pay Plan, Series & Grade: 

Organization: Directorate: 

Division: 

Branch/Office: 

Type of Employment: Full Time Part Time Seasonal 

Total Hours Worked Per Week: to 

Length of Time in this Position: 

Term Temporary 

Work Schedule (start/stop time): 

Length of Time Supervised by Supervisor: 

Name of Supervisor: Supervisor's Position Title: 

Is the position description current and accurate? No Yes (please attach copy) 

Is the position under review in a compensation or classification matter? No Yes 

Are other employees assigned to this position description? No Yes, (#) employees. 

PART II - PRIMARY PURPOSE OF POSITION 

Briefly summarize the purpose, the degree of expertise and required skills of the position. Use continuation pages if necessary.

PART III - LEADERSHIP/SUPERVISORY RESPONSIBILITIES 

Check the response that most accurately describes the employee's leadership/supervisory responsibilities. 

No supervisory or leadership responsibility 

Team leader 

Supervisor of one or more staff members 

PART IV - ESSENTIAL AND NON-ESSENTIAL FUNCTIONS 

The purpose of this section is to distinguish between essential functions (major duties) and non-essential functions (marginal duties) of the employee’s 

position. Although both essential functions/and non-essential functions may be accommodated by changing how or when the functions are performed, it is 

important to differentiate between the two types of functions because to be qualified"for a position, an employee must be able to perform the essential

functions of the position,with or without reasonable accommodation. Alternatively, if an employee is unable to perform a particular marginallfunction due to 

his or her medical condition(s), that function could simply be removed or swapped with another marginal function. This questionnaire will assist you with 

evaluating the functions of the position to determine if reasonable accommodation solutions can be implemented that will enable the employee to 

successfully perform the duties of their position. List one job function per page (essential functions first, then marginal functions.) Delete unused pages. 

The Job Analysis Questionnaire is a snapshot”in time of the employee's assigned duties that may change over time. Do not rely on a generic position 

description when completing this Questionnaire. HELPFUL TIP: The total of all “percentage of time spent on this function” fields listed on this 

questionnaire should equal 100%.

Essential Functions

An essential function is a job duty so fundamental to a position that the position requirements cannot be fulfilled without successful performance of the 

duty. For example, an essential job function for a cashier is to exchange money with customers, or an essential job function of a pilot is to fly planes. 

To determine if a function is essential, consider:

• What are the significant implications if this employee does not perform the function;

• The size of the work unit and whether other employees can perform the function;

• Whether a significant amount of time is spent performing the function; however, a function may be essential even if an insignificant amount of time is

spent performing it. For example, landing a plane may only take 15 minutes of an 8-hour flight, but it is an essential function of the pilot’s job because

the consequences are so serious if the pilot does not perform that function;

• If the employee was specifically hired to perform the highly specialized function because of his/her expertise in performing that function.

Non-Essential Functions 

Non-essential/marginal job functions are those that do not affect the character of the job (scope of the responsibility, type of work, major duties.) “Marginal” 

does not mean unimportant; for these purposes, marginal just means those functions that are incidental or a minimal part of the job. A function may be nonessential or marginal if: 

• the essence of the job would remain the same if the duty were not performed.

• the function could be reassigned to other employees with only moderate disruption or inconvenience.

• failure to perform the function may have only minor consequences.

FLETC Form 256-05-02 (01/20)20)
REASONABLE ACCOMMODATION JOB ANALYSIS QUESTIONNAIRE (Continued) 

Major Duty/Essential Function # 1

Description of Duty 

Frequency of this function (daily, 

weekly, monthly, quarterly, annually) 

Percentage of time spent on this function 

Competencies or abilities required for this 

function 

Work environment for this function 

Equipment/tools/machines used to 

perform this function 

Required licenses, certifications, 

qualifications for this function 

Does this function require work outside the 

normal duty day? If yes, provide details 

regarding shift assignments (i.e., night 

labs, holidays, weekends, etc.). 

No Yes 

Does this function require travel? If yes, 

address mode of travel, locations, travel 

time, and frequency. 

No Yes 

Does this function require the employee to 

work with others? If yes, provide details. 

No Yes 

Routine Internal and External Personal/Organizational Contacts for this function: 

Individual/Organization Purpose of Contact Frequency of Contact 

Give an example to explain how this major duty is performed and list any additional requirements of this major duty/essential function

(use continuation pages if necessary): 

Considering the employee's medical limitation(s), list any reasonable accommodation solutions that may assist the employee 

to perform this major duty/essential function use continuation pages if necessary): 

FLETC Form 256-05-02 (01/20) 
REASONABLE ACCOMMODATION JOB ANALYSIS QUESTIONNAIRE (Continued) 

Major Duty/Essential Function # 2 

Description of Duty 

Frequency of this function (daily, 

weekly, monthly, quarterly, annually) 

Percentage of time spent on this function 

Competencies or abilities required for this 

function 

Work environment for this function 

Equipment/tools/machines used to 

perform this function 

Required licenses, certifications, 

qualifications for this function 

Does this function require work outside the 

normal duty day? If yes, provide details 

regarding shift assignments (i.e., night 

labs, holidays, weekends, etc.). 

No Yes 

Does this function require travel? If yes, 

address mode of travel, locations, travel 

time, and frequency. 

No Yes 

Does this function require the employee to 

work with others? If yes, provide details. 

No Yes 

Routine Internal and External Personal/Organizational Contacts for this function: 

Individual/Organization Purpose of Contact Frequency of Contact 

Give an example to explain how this major duty is performed and list any additional requirements of this major duty/essential function (use 

continuation pages if necessary): 

Considering the employee's medical limitation(s), list any reasonable accommodation solutions that may assist the employee 

to perform this major duty/essential function use continuation pages if necessary): 

FLETC Form 256-05-02 (01/20) 
REASONABLE ACCOMMODATION JOB ANALYSIS QUESTIONNAIRE (Continued) 

Major Duty/Essential Function # 3 

Description of Duty 

Frequency of this function (daily, 

weekly, monthly, quarterly, annually) 

Percentage of time spent on this function 

Competencies or abilities required for this 

function 

Work environment for this function 

Equipment/tools/machines used to 

perform this function 

Required licenses, certifications, 

qualifications for this function 

Does this function require work outside the 

normal duty day? If yes, provide details 

regarding shift assignments (i.e., night 

labs, holidays, weekends, etc.). 

No Yes 

Does this function require travel? If yes, 

address mode of travel, locations, travel 

time, and frequency. 

No Yes 

Does this function require the employee to 

work with others? If yes, provide details. 

No Yes 

Routine Internal and External Personal/Organizational Contacts for this function: 

Individual/Organization Purpose of Contact Frequency of Contact 

Give an example to explain how this major duty is performed and list any additional requirements of this major duty/essential function (use 

continuation pages if necessary): 

Considering the employee's medical limitation(s), list any reasonable accommodation solutions that ay assist the employee 

to perform this major duty/essential function use continuation pages if necessary): 

FLETC Form 256-05-02 (01/20) 
REASONABLE ACCOMMODATION JOB ANALYSIS QUESTIONNAIRE (Continued) 

Major Duty/Essential Function # 4 

Description of Duty 

Frequency of this function (daily, 

weekly, monthly, quarterly, annually) 

Percentage of time spent on this function 

Competencies or abilities required for this 

function 

Work environment for this function 

Equipment/tools/machines used to 

perform this function 

Required licenses, certifications, 

qualifications for this function 

Does this function require work outside the 

normal duty day? If yes, provide details 

regarding shift assignments (i.e., night 

labs, holidays, weekends, etc.). 

No Yes 

Does this function require travel? If yes, 

address mode of travel, locations, travel 

time, and frequency. 

No Yes 

Does this function require the employee to 

work with others? If yes, provide details. 

No Yes 

Routine Internal and External Personal/Organizational Contacts for this function: 

Individual/Organization Purpose of Contact Frequency of Contact 

Give an example to explain how this major duty is performed and list any additional requirements of this major duty/essential function (use 

continuation pages if necessary): 

Considering the employee's medical limitation(s), list any reasonable accommodation solutions that may assist the employee to perform this 

major duty/essential function (use continuation pages if necessary):

FLETC Form 256-05-02 (01/20) 
REASONABLE ACCOMMODATION JOB ANALYSIS QUESTIONNAIRE (Continued) 

Major Duty/Essential Function # 5 

Description of Duty 

Frequency of this function (daily, 

weekly, monthly, quarterly, annually) 

Percentage of time spent on this function 

Competencies or abilities required for this 

function 

Work environment for this function 

Equipment/tools/machines used to 

perform this function 

Required licenses, certifications, 

qualifications for this function 

Does this function require work outside the 

normal duty day? If yes, provide details 

regarding shift assignments (i.e., night 

labs, holidays, weekends, etc.). 

No Yes 

Does this function require travel? If yes, 

address mode of travel, locations, travel 

time, and frequency. 

No Yes 

Does this function require the employee to 

work with others? If yes, provide details. 

No Yes 

Routine Internal and External Personal/Organizational Contacts for this function: 

Individual/Organization Purpose of Contact Frequency of Contact 

Give an example to explain how this major duty is performed and list any additional requirements of this major duty/essential function

(use continuation pages if necessary): 

Considering the employee's medical limitation(s), list any reasonable accommodation solutions that may assist the employee 

to perform this major duty/essential function use continuation pages if necessary): 

FLETC Form 256-05-02 (01/20) 
REASONABLE ACCOMMODATION JOB ANALYSIS QUESTIONNAIRE (Continued) 

Non Essential Function # 1 

Description of Duty 

Frequency of this function (daily, 

weekly, monthly, quarterly, annually) 

Percentage of time spent on this function 

Competencies or abilities required for this 

function 

Work environment for this function 

Equipment/tools/machines used to 

perform this function 

Required licenses, certifications, 

qualifications for this function 

Does this function require work outside the 

normal duty day? If yes, provide details 

regarding shift assignments (i.e., night 

labs, holidays, weekends, etc.). 

No Yes 

Does this function require travel? If yes, 

address mode of travel, locations, travel 

time, and frequency. 

No Yes 

Does this function require the employee to 

work with others? If yes, provide details. 

No Yes 

Give an example to explain how this major duty is performed and list any additional requirements of this major duty/essential function (use 

continuation pages if necessary): 

FLETC Form 256-05-02 (01/20) 

Considering the employee's medical limitation(s), list any reasonable accommodation solutions that may assist the employee to perform this 

marginall (non-essential) function (use continuation pages if necessary): 
REASONABLE ACCOMMODATION JOB ANALYSIS QUESTIONNAIRE (Continued) 

Non Essential Function # 2 

Description of Duty 

Frequency of this function (daily, 

weekly, monthly, quarterly, annually) 

Percentage of time spent on this function 

Competencies or abilities required for this 

function 

Work environment for this function 

Equipment/tools/machines used to 

perform this function 

Required licenses, certifications, 

qualifications for this function 

Does this function require work outside the 

normal duty day? If yes, provide details 

regarding shift assignments (i.e., night 

labs, holidays, weekends, etc.). 

No Yes 

Does this function require travel? If yes, 

address mode of travel, locations, travel 

time, and frequency. 

No Yes 

Does this function require the employee to 

work with others? If yes, provide details. 

No Yes 

Give an example to explain how this major duty is performed and list any additional requirements of this major duty/essential function (use 

continuation pages if necessary): 

FLETC Form 256-05-02 (01/20) 

Considering the employee's medical limitation(s), list any reasonable accommodation solutions that may assist the employee to perform this 

marginal (non-essential) function (use continuation pages if necessary): 
REASONABLE ACCOMMODATION JOB ANALYSIS QUESTIONNAIRE (Continued) 

Non Essential Function # 3 

Description of Duty 

Frequency of this function (daily, 

weekly, monthly, quarterly, annually) 

Percentage of time spent on this function 

Competencies or abilities required for this 

function 

Work environment for this function 

Equipment/tools/machines used to 

perform this function 

Required licenses, certifications, 

qualifications for this function 

Does this function require work outside the 

normal duty day? If yes, provide details 

regarding shift assignments (i.e., night 

labs, holidays, weekends, etc.). 

No Yes 

Does this function require travel? If yes, 

address mode of travel, locations, travel 

time, and frequency. 

No Yes 

Does this function require the employee to 

work with others? If yes, provide details. 

No Yes 

Give an example to explain how this major duty is performed and list any additional requirements of this major duty/essential function (use 

continuation pages if necessary): 

FLETC Form 256-05-02 (01/20) 

Considering the employee's medical limitation(s), list any reasonable accommodation solutions that may assist the employee 

to perform this marginal (non-essential) function (use continuation pages if necessary): 
REASONABLE ACCOMMODATION JOB ANALYSIS QUESTIONNAIRE (Continued) 

Non Essential Function # 4 

Description of Duty 

Frequency of this function (daily, 

weekly, monthly, quarterly, annually) 

Percentage of time spent on this function 

Competencies or abilities required for this 

function 

Work environment for this function 

Equipment/tools/machines used to 

perform this function 

Required licenses, certifications, 

qualifications for this function 

Does this function require work outside the 

normal duty day? If yes, provide details 

regarding shift assignments (i.e., night 

labs, holidays, weekends, etc.). 

No Yes 

Does this function require travel? If yes, 

address mode of travel, locations, travel 

time, and frequency. 

No Yes 

Does this function require the employee to 

work with others? If yes, provide details. 

No Yes 

Give an example to explain how this major duty is performed and list any additional requirements of this major duty/essential function (use 

continuation pages if necessary): 

FLETC Form 256-05-02 (01/20) 

Considering the employee's medical limitation(s), list any reasonable accommodation solutions that may assist the employee to perform this 

marginal (non-essential) function (use continuation pages if necessary): 
 

REASONABLE ACCOMMODATION JOB ANALYSIS QUESTIONNAIRE (Continued) 

PART V - IDENTIFICATION OF INDIVIDUAL COMPLETING FORM 

Name: 

Position Title: 

Relationship to Requestor: 

Signature of Individual Completing the Form Date 

FLETC Form 256-05-02 (01/20) 
REASONABLE ACCOMMODATION JOB ANALYSIS QUESTIONNAIRE (Continuation Page #1)

FLETC Form 256-05-02 (01/20) 
REASONABLE ACCOMMODATION JOB ANALYSIS QUESTIONNAIRE (Continuation Page #2)

FLETC Form 256-05-02 (01/20)