ORS Form 4 PPD-4G

U.S. Department of Labor

Bureau of Labor Statistics 

Occupational Requirements 

Survey

State and local government

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local governments. Upon your request, however, the BLS 

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Schedule number: Start: End:

Total Employment: PSO Employment:

Selected Occupations Occ. Emp. FT/PT SOC

1

2

3

4

5

6

7

8

PRINT ADDITIONAL COPIES OF PAGES 2-4, AS NEEDED.
Schedule/Quote: ___________ Work Schedule: ____________

 Job Title Work Schedule Job Description (Y/N) FT/PT

Job Observation (circle): Yes - requested Yes - offered No

Critical Job Function:

Task List: Minimum Education

Experience

Credentials

On the Job Training

10% Tasks: Driving (yes/no)

Vehicle Type?

Supervisory Data:

Lead/Supervisor/Manager/None

Work Checked: (more than 1x/day, 1x/day, 

At least 1x/week, less than weekly)

Supervisor Present? Y/N

Work-Related Communication:

Verbal Interactions (every few min, more than 1x/hour, more than 1x/day, once per day or less)

Speaking (duration)

People Skills (basic, more than basic)

General Public? Y/N Crowds? Y/N Telework? Y/N
Job Title Work Schedule

Hearing: 

 In-Person Speech? Y/N Telephone? Y/N Other Remote Speech? Y/N Other Sounds? Y/N

 Noise Intensity Level (quiet, moderate, loud, very loud)

 PPE? Y/N

Cognitive:

Control of Work Load? (machinery/equip/software, numerical perf. target, people, self-paced, other)

Work Pace? (consistent-fast, consistent-slow, varies)

Ability to step away? Y/N

Problem Solving? (more than 1x/day, 1x/day, at least 1x/week, at least 1x/month, less than 1x/month)

Sit/Stand/Walk Duration Other Notes

 Sitting

 Standing/Walking

 Sitting/Standing at Will Y/N

Lift/Carry (breaks at 1/10/25/50/75/100 lbs)

Most weight ever

2/3 of the time or more

1/3 up to 2/3 of the time

2% up to 1/3 of the time

Seldom (up to 2%)

Pushing/Pulling

Hands/Arms One/Both

Feet/Legs One/Both

Reaching/Manipulation

Overhead Reaching One/Both

At/Below Shoulder Reaching One/Both

Gross Manipulation One/Both

Fine Manipulation One/Both

Foot/Leg Controls One/Both

Traditional Keyboarding

Postural

Work at or below knee level Y/N/Unk

Stooping Reqd/Choice

/No/Unk

Kneeling Reqd/Choice

/No/Unk

Crouching Reqd/Choice

/No/Unk

Crawling Reqd/Choice

/No/Unk
Job Title Work Schedule

Postural – Climbing Duration Other Notes

Ramps or Stairs, Structural Y/N

Ramps or Stairs, Workrelated

Ladders, Ropes, or Scaffolds

High, Exposed Places Y/N PPE

Vision

Near Visual Acuity Y/N

Far Visual Acuity Y/N

Peripheral Vision Y/N

Environmental Conditions

Outdoors

Extreme Heat

Extreme Cold

Wetness

Humidity

Heavy Vibration

Hazardous Contaminants Y/N PPE

Proximity to Moving 

Mechanical Parts Y/N PPE