ORS FORM 4: PPD-4GF 1 

U.S. Department of Labor

Bureau of Labor Statistics 

Occupational Requirements Survey

State and local government

The Bureau of Labor Statistics publishes statistical tabulations from this survey 

that may reveal the information reported by individual State and local 

governments. Upon your request, however, the BLS will hold the information 

provided on this survey form in confidence.

This report is authorized by law, 31 United States 

Code §§ 1535/FAR 17.5 of the Economy Act. 

Your voluntary cooperation is needed to make the 

results of this survey comprehensive, accurate 

and timely.

O.M.B. #1220-0189

Expires 8/31/2021

We estimate that it will take an average of 66 minutes to complete this form, including time for reviewing instructions, searching existing data sources, gathering and 

maintaining the data needed, and completing and reviewing this information. If you have any comments regarding this estimate or any other aspect of this survey 

including suggestions for reducing this burden, please send them to the Bureau of Labor Statistics, Office of Compensation and Working Conditions (1220-0189), 2 

Massachusetts Avenue N.E., Washington, D.C. 20212. You are not required to respond to the collection of information unless it displays a currently valid OMB 

control number. 

ESTABLISHMENT INFORMATION

Establishment Name

Schedule Number Quote Number

JOB INFORMATION & REQUIREMENTS Job Description: ☐ Yes ☐ No

Job Title 

# Full-time Employees Full-time Work Schedule

# Part-time Employees Part-time Work Schedule

Minimum Education

Experience

Non-Degree Credentials

On-the-Job-Training

CRITICAL JOB FUNCTION & TASKS

Critical Job Function 

Critical Tasks

10% Tasks
ORS FORM 4: PPD-4GF 2 

SUPERVISORY INFORMATION

Supervisory Duties: ☐ None ☐ Lead Worker ☐ Supervisor ☐ Manager

Frequency of Work Being Checked: ☐ More than once per day ☐ Once per day

☐ Less than once per day, but at least once per week ☐ Less often than weekly

Supervisor Present: ☐ Yes ☐ No

COMMUNICATION & HEARING

Work Related Communication

Speaking: (Duration – % of time)

☐ Up to 2% ☐ 2% up to 1/3 ☐ 1/3 up to 2/3 ☐ 2/3 or more ☐ Not Present ☐ Present, Duration Unknown

Verbal Interactions: ☐ Constantly, every few minutes ☐ Not constantly, but more than once per hour

☐ Not more than once per hour, but more than once per day ☐ Once per day or less often

People Skills: ☐ Basic ☐ More than Basic Working with the General Public: ☐ Yes ☐ No

Working Around Crowds: ☐ Yes ☐ No Telework: ☐ Yes ☐ No

Hearing

In-person Speech: ☐ Yes ☐ No Telephone: ☐ Yes ☐ No

Other Remote Speech: ☐ Yes ☐ No Other Sounds: ☐ Yes ☐ No

Noise Intensity Level: ☐ Quiet ☐ Moderate ☐ Loud ☐ Very Loud

Personal Protective Equipment (PPE): ☐ Yes ☐ No

COGNITIVE DEMANDS

Control of Workload: 

☐ Machinery, equipment or software ☐ Numerical performance targets (company determined)

☐ People (such as customers, supervisor, etc.) ☐ Self-paced by worker ☐ Other (specify) _________

Work Pace: ☐ Consistent – Fast ☐ Consistent – Slow ☐ Varies

Pause Control (ability to step away): ☐ Yes ☐ No 

Problem Solving: 

☐ More than once per day ☐ Once per day ☐ Not every day, but at least once per week

☐ Not every week, but at least once per month ☐ Less often than monthly, including never
ORS FORM 4: PPD-4GF 3 

PHYSICAL DEMANDS

Sitting vs. Standing/Walking Sit/Stand at Will: ☐ Yes ☐ No

Sitting (hours or percent) Standing/Walking (hours or percent) 

Lifting/Carrying 

Most Weight Ever Lifted lbs. Items lifted

Seldom

(Up to 2% of the time)

Occasional

(2% up to 1/3 of the time)

Frequent

(1/3 up to 2/3 of the time)

Constant

(2/3 or more or the time)

☐ None ☐ None ☐ None ☐ None

☐ Negligible ☐ Negligible ☐ Negligible ☐ Negligible

☐ 1 to 10 lbs. ☐ 1 to 10 lbs. ☐ 1 to 10 lbs. ☐ 1 to 10 lbs.

☐ 11 to 25 lbs. ☐ 11 to 25 lbs. ☐ 11 to 25 lbs. ☐ 11 to 25 lbs.

☐ 26 to 50 lbs. ☐ 26 to 50 lbs. ☐ 26 to 50 lbs. ☐ >25 lbs.

☐ 51 to 75 lbs. ☐ 51 to 75 lbs. ☐ >50 lbs.

☐ 76 to 100 lbs. ☐ 76 to 100 lbs.

☐ >100 lbs. ☐ >100 lbs.

Pushing/Pulling 

Up to 2% 2% up to

1/3 

1/3 up to 

2/3 2/3 or More Not Present

Present, 

Duration 

Unknown

Hands/Arms: ☐ ☐ ☐ ☐ ☐ ☐ ☐

Feet/Legs: ☐ ☐ ☐ ☐ ☐ ☐ ☐

Reaching/Manipulation

Up to 2% 2% up to

1/3 

1/3 up to 

2/3 2/3 or More Not Present

Present, 

Duration 

Unknown

One / Both

Overhead 

Reaching:

☐ ☐ ☐ ☐ ☐ ☐ ☐

At/Below 

Shoulder 

Reaching:

☐ ☐ ☐ ☐ ☐ ☐ ☐

Gross 

Manipulation:

☐ ☐ ☐ ☐ ☐ ☐ ☐

Fine 

Manipulation:

☐ ☐ ☐ ☐ ☐ ☐ ☐

Foot/Leg 

Controls: 

☐ ☐ ☐ ☐ ☐ ☐ ☐

Keyboarding: ☐ ☐ ☐ ☐ ☐ ☐

Note: Duration % = percentage of the worker’s time

☐

☐

☐

☐

☐

☐

☐

One / Both
ORS FORM 4: PPD-4GF 4 

Postural

Up to 2% 2% up

to 1/3 

1/3 up to 

2/3 

2/3 or 

More 

Not 

Present

Present, 

Duration 

Unknown

Work At/Below Knee Level: ☐ ☐ ☐ ☐ ☐ ☐

Stooping: ☐ Yes-Required ☐ Yes-Choice ☐ No ☐ Unknown

Kneeling: ☐ Yes-Required ☐ Yes-Choice ☐ No ☐ Unknown

Crouching: ☐ Yes-Required ☐ Yes-Choice ☐ No ☐ Unknown

Crawling: ☐ Yes-Required ☐ Yes-Choice ☐ No ☐ Unknown

Climbing 

Ramps or Stairs, Structural: ☐ Yes ☐ No

Up to 2% 2% up to 

1/3 

1/3 up to 

2/3 

2/3 or 

More Not Present

Present, 

Duration 

Unknown

Personal 

Protective 

Equipment 

Ramps/Stairs, 

WorkRelated:

☐ ☐ ☐ ☐ ☐ ☐

Ladders/ 

Ropes, or 

Scaffolds:

☐ ☐ ☐ ☐ ☐ ☐

High, Exposed 

Places:

☐ ☐ ☐ ☐ ☐ ☐ ☐

Vision 

Near Visual Acuity: ☐ Yes ☐ No Far Visual Acuity: ☐ Yes ☐ No

Peripheral Vision: ☐ Yes ☐ No Driving: ☐ Yes ☐ No Vehicle: _________________

ENVIRONMENTAL CONDITIONS

Up to 2% 2% up to

1/3 

1/3 up to 

2/3 

2/3 or 

More Not Present

Present, 

Duration 

Unknown

Personal 

Protective 

Equipment 

Outdoors: ☐ ☐ ☐ ☐ ☐ ☐

Extreme Heat ☐ ☐ ☐ ☐ ☐ ☐

Extreme Cold: ☐ ☐ ☐ ☐ ☐ ☐

Wetness: ☐ ☐ ☐ ☐ ☐ ☐

Humidity: ☐ ☐ ☐ ☐ ☐ ☐

Heavy 

Vibration: ☐ ☐ ☐ ☐ ☐ ☐

Hazardous 

Contaminants: 

☐ ☐ ☐ ☐ ☐ ☐ ☐

Proximity to 

Moving 

Mechanical 

Parts:

☐ ☐ ☐ ☐ ☐ ☐ ☐