ORS FORM 4: PPD-4GF 1 

U.S. Department of Labor

Bureau of Labor Statistics 

Occupational Requirements Survey

State and local government

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ESTABLISHMENT INFORMATION

Establishment Name

Schedule Number Quote Number

JOB INFORMATION & REQUIREMENTS Job Observed: ☐ 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

Job Description: ☐ Yes ☐ No
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. ☐ >25 lbs. ☐ Unknown

☐ 76 to 100 lbs. ☐ 76 to 100 lbs. ☐ Unknown

☐ >100 lbs. ☐ >100 lbs.

☐ Unknown ☐ Unknown

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

One / Both

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

 None = Lift/Carry not present for duration 
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:

☐ ☐ ☐ ☐ ☐ ☐ ☐