The purpose of the Job Demands Checklist is to provide a detailed description of both physical and cognitive job demands as well as exposure to environmental factors. It should be reviewed regularly by the Manager in consultation with staff members e.g. at recruitment, with any change in work tasks or annually. The job demands checklist should be attached to the Position Description.
Critical demands are any demands that are frequent or constant or are deemed to be essential to the job. Tick the critical demands on the left hand column of the job demands checklist. Critical demands should then also be listed below and included in the Position Description.
Job Title: Registered NurseDepartment: Perioperative Services
Manager/Supervisor:M.T ButlerDate Developed: Jan 2017
Frequency Assessment:
R / Rare i.e. occurs 0 <5% of day(Total of 3 minutes in the hour) / C / Constant i.e. occurs 67 < 100%
(Total of 40-60 minutes in the hour)
O / Occasional i.e. occurs 6<33% of day
(Total of 3-20 minutes in the hour) / N/A / Not applicable – activity is not required to perform the job
F / Frequent i.e. occurs 34<66% of day
(Total of 20-40 minutes in the hour)
Work Hours / Conditions: Workday (length & Frequency of shifts):
Rotating Roster x Day Shift x Evening Shift x Night Shift xExtended Shift e.g. 10-12 hours xOn Call
Comment:
√ Denotes critical requirement of the job
CRITICAL√ / PSYCHOSOCIAL DEMANDS – DESCRIPTIONComments: / FREQUENCY
R / O / F / C / N/A
Interaction with distressed people e.g. emergency or grief situations / x
Interaction with aggressive & uncooperative people e.g. drug/alcohol,
Dementia, mental illness / x
Interaction with unpredictable people e.g. dementia, mental illness, head injuries / x
Exposure to distressing situations e.g. child abuse, viewing dead/mutilated bodies / x
Problem Solving & Decision Making / x
Team Work / x
Working Alone / x
Other
CRITICAL√ / PHYSICAL DEMANDS – DESCRIPTION
Comments: / FREQUENCY
R / O / F / C / N/A
Sitting / x
Standing Remaining standing without moving about to perform tasks / x
Walking / x
Running / x
Bend/ Lean Forward from Waist / x
Trunk TwistingTurning from the waist while sitting or standing to perform tasks / x
Kneeling / x
Squatting /CrouchingAdopting a squatting or crouching posture to perform tasks / x
CrawlingMoving by crawling on knees & hands to perform tasks / x
Leg / Foot Movementto operate machinery / x
Climbing (Stairs/ladders/steps) / x
Lifting / Carrying / Light Lifting & Carrying 0 – 5kg / x
Moderate Lifting & Carrying 5-10kg / x
Heavy Lifting & Carrying 10-15kg / x
Very Heavy Lifting & Carrying 15kg and above / x
Overhead ReachingArms raised above shoulder / x
Forward ReachingArms fully extended forward / x
Pushing / Pulling / x
Restraining Using force to hold/restrain or move objects toward or away from body / x
Head / Neck PosturesHolding head in a position other than neutral (Facing Forward) / x
Hand & Arm MovementsRepetitive movements of hands & arms / x
Grasping / Fin Manipulation Gripping, holding, clasping with fingers or hands / x
Computer Work / x
Work at HeightsUsing ladders, footstools, scaffolding, or other objects to perform work / x
DrivingOperating any motor powered vehicle / x
Other
CRITICAL√ / SENSORY DEMANDS – DESCRIPTION
Comments: / FREQUENCY
R / O / F / C / N/A
Sight Use of sight is an integral part of work performance eg. viewing of X-rays, computer / x
HearingUse of hearing is an integral part of work performance eg. telephone enquiries / x
Smell Use of smell is an integral part of work performance eg. working with chemicals / x
Taste Use of taste is an integral part of work performance eg. food preparation / x
TouchUse of touch is an integral part of work performance / x
Colour Discrimination Distinguishes between different colours, shades / x
CRITICAL√ / ENVIRONMENTAL HAZARDS – DESCRIPTION
Comments: / FREQUENCY
R / O / F / C / N/A
Dust Exposure to atmospheric dust / x
Toxic Chemicals / Gas Working with explosive / flammable gases requiring precautionary measures / x
Noise Environmental / background noise necessitates people to raise their voice to be heard / x
Flashing lighting Risk of trips, falls or eyestrain / x
Sunlight Risk of sunburn exists from spending more than 10 minutes per work day in sunlight / x
Extreme temperatures Environmental temperatures are < 15C or > 35C / x
Confined spaces Areas where only one egress (escape route) exists / x
Slippery or uneven surfaces Greasy or wet floor surfaces, ramps, uneven ground / x
Working at heights Ladders/stepladders/ scaffolding are required to perform tasks / x
Biological hazards e.g. exposure to body fluids, bacteria, infectious diseases / x
Frequent Hand Washing / x
Latex e.g. gloves / x
Radiation Exposure / x
Working with Cytotoxics / x
Other
CRITICAL√ / PERSONAL PROTECTIVE EQUIPMENT – DESCRIPTION
Comments: / FREQUENCY
R / O / F / C / N/A
Gloves / x
Hearing Protection / x
Eye Protection / x
Lead Apron / x
Safety Boots / x
Other
HEALTH DECLARATION FORM
Dear Applicant,
St Vincent’s and Mater Health Sydney is an Equal Opportunity employer and as such will not consider any discriminatory practices in terms of recruitment procedures.
The Health Declaration Form is provided to seek comment from you about any health condition or disability that may impact upon your ability to undertake the duties inherent in the position.
In accordance with our duty of care and Occupational Health and Safety requirements we must ensure that employees are not exposed to risk that will impact upon their physical and mental wellbeing. In providing a commitment to this philosophy we require that you complete this declaration to create an awareness of any factors that will impact upon your future employment. Adjustment may be made where possible to workplace environments minimising the risk of injury.
It is therefore requested that you complete the Health Declaration Form. You may be required to attend a medical assessment to determine whether:
•You are able to perform the inherent job requirements and job demands of the position
•Any adjustments are needed to enable you to perform the inherent requirements and job demands of the position
•The nature of any adjustments required
Definitions
Position Description:
A Position Description is a detailed description of the nature of the position including the duties of the position and the abilities, qualifications, experience, standard of work performance, job requirements and job demands and personal qualities of those persons required to fill the position.
Job Requirements:
Job requirements are the requirements that are fundamental, intrinsic or essential to the position.
Adjustments:
Adjustments are used to refer to the provision of services, facilities or working arrangements which allow an individual with a disability to carry out the inherent requirements of the job. Adjustments must be provided where their provision does not cause the employer unjustifiable hardship.
Applicant Health Declaration:
I have read and understood the details and requirements of the position as contained in the Position Description and Job Demands Checklist and agree that:
I can fulfil the requirements of the position without modification i.e. I am not aware of any health condition or disability which might interfere with my ability to undertake the inherent job requirements and job demands of the position. / Yes No
I have a health condition / disability / special needs that may require the employer to provide me with adjustments (services or facilities) so that I can successfully carry out the inherent requirements and job demands of the position. / Yes
No
I understand that adjustments to the workplace can be made to assist employees with disabilities / special needs in carrying out the inherent job requirements and job demands of the position.
Any adjustments I need have been discussed with the organisation prior to completing this health declaration. / Yes
No
I need the following adjustments or modifications in order to perform the job demands of the position:
______
______
______
______
I am aware that any false or misleading statements may threaten my appointment or continued employment with St Vincent’s Public Hospital or any of its facilities.
Name of Applicant: ______
Signature: ______Date: ______
Manager Comment:
Adjustments would be required for applicant to fulfil the inherent requirements of
the position. Adjustments required are:
______
______
Despite adjustment, applicant still unable to undertake inherent requirements of the
position or provision of adjustments would cause employer unjustifiable hardship.
Consultation required with HR / OHS Department in cases where adjustments
required.
Manager: ______
Position: ______
Signature: ______Date: ______
Doc No. 000.100 Job Demands Checklist & Health Declaration Form Page 1