Free 43434.pdf - Indiana

JOB ANALYSIS QUESTIONNAIRE
(PAT, COMOT, LTC, POLE, & SAM CATEGORIES)
State Form 43434 (R2 / 7-05)

(Please Type or Print) Employee's Name: Date: Agency: Section/District: Job Title (as on staffing report): Working Title (if different from above): Supervisor's Name: Supervisor's Job Title: INSTRUCTIONS FOR FILLING OUT THIS QUESTIONNAIRE CERTAIN QUESTIONS MAY NOT APPLY TO YOUR POSITION. IF SO PLEASE MARK N/A. This questionnaire will serve as the basis for evaluating your position and/or drafting your job description. Please do not use technical jargon or abbreviations known only to members of your department or field. We realize that careful completion of this form may take some time, however complete and detailed answers will help us to accurately evaluate your position and/or write an accurate job description. Please attach additional sheets if necessary. We appreciate your help in this regard. (a) (b) (c) (d) (e) (f) If possible, please complete electronically. If not, complete in ink. Do not use pencil. Replies should be complete, concise and factual. This form may be completed on work time. Give your completed questionnaire directly to your supervisor. The questionnaire will be reviewed by your supervisor. You will be informed of any changes. Carefully read the entire questionnaire before answering to avoid duplicate responses. Please be sure to complete all pages. Phone: Phone: Division: Unit:

SUPERVISORS: It is your responsibility to review this completed questionnaire and ensure the accuracy of its contents. FOR HUMAN RESOURCES DIVISION USE ONLY: Class Code: Class Title: Position Number:

Indiana State Personnel Department Division of Organizational Design & Development

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PURPOSE OF POSITION: Describe your position in detail by stating the purpose, goals and objectives, as you understand them. Identify the unit, position or section where you are assigned and include how your position contributes to the agency, division, and/or work group.

Indiana State Personnel Department Division of Organizational Design & Development

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DUTIES, KNOWLEDGE AND ABILITIES
Please summarize your primary duties and list the amount of time spent performing each duty (total of 100% or a whole work day), the frequency of each duty, importance of each duty, and the required knowledge, skills and abilities for each duty. List the most important duty first and only list those duties that total 10% or more of your time spent. DUTIES Example: Inspect building for damage such as broken doors, leaky faucets, etc... TIME Example: 10% FREQUENCY Example: Monthly Daily Monthly Annually IMPORTANCE Example: Medium Low Medium High KNOWLEDGE, SKILLS, & ABILITIES Example: Ability to prioritize carpentry repairs and determine source of problems.

Daily Monthly Annually

Low Medium High

Daily Monthly Annually

Low Medium High

Daily Monthly Annually

Low Medium High

Daily Monthly Annually

Low Medium High

Daily Monthly Annually

Low Medium High

Daily Monthly Annually

Low Medium High

Daily Monthly Annually

Low Medium High

Daily Monthly Annually

Low Medium High

Daily Monthly Annually
Indiana State Personnel Department Division of Organizational Design & Development

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List all specialized tools, equipment and machines used on your job. TYPE Example: Back Hoe Example: Excavation PURPOSE

PLEASE NOTE: LAWS, REGULATIONS, ETC. ARE ADDRESSED UNDER DIFFICULTY OF WORK JOB REQUIREMENTS Education ­ Check the box that best indicates the minimum training/education requirements of this job. (Not necessarily your education, but the requirements for the job). EDUCATION High school diploma or GED Vocational/Technical/Business School Some college or Associate's (2 yr) degree Bachelor's Degree Specialized Areas of Study / Majors: Master's Degree Doctorate Degree Other:

Indiana State Personnel Department Division of Organizational Design & Development

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List any required and job-related certifications, licenses, or other special training. CERTIFICATION(S) SPECIAL TRAINING LICENSES

Experience ­ Check the box, which best indicates the minimum amount of experience required to perform the job. (Not necessarily your years of experience, but the requirements of the job). REQUIRED EXPERIENCE Less than 6 months 6 months, but less than 1 year 1 year, but less than 3 years Special Types of Experience Required: 3 years, but less than 5 years 5 years, but less than 7 years 7 or more years

What, if any, principles, theories, and/or precedents are required to perform the job?

Which of the following best describes the level of understanding required on a regular basis? (Check one) Understand verbal work orders and instructions. Understand short notes, brief forms or instructions. Understand material such as detailed forms, standard memos or letters. Understand and comprehend material such as detailed operating and procedure manuals, case histories, blueprints and diagrams. Understand and comprehend material such as very specialized and technical manuals. Please give examples of the above:

Indiana State Personnel Department Division of Organizational Design & Development

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Does your job require you to develop new work methods, procedures, policies or manuals? If yes, please explain and/or provide examples. Yes No

DIFFICULTY OF WORK Please list the source materials you use in performing your job. Materials may include handbooks, manuals, textbooks, laws, rules, regulations, policies, practices, techniques, etc... HOW OFTEN DO YOU APPLY THIS INFORMATION? Example: Weekly WHEN UNSURE OF HOW TO APPLY THIS INFORMATION, HOW DO YOU OBTAIN CLARIFICATION? Example: Consult co-worker, supervisor or technical support.

LIST Example: Microsoft Excel Users Guide

Indiana State Personnel Department Division of Organizational Design & Development

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What are the most difficult duties of your job? Explain in terms of complexity of assignments, problem solving and methods used to complete assignments.

RESPONSIBILITY Give an example of the most important decision you can make and what person (list their title) or body of government can overrule the decision. DECISION AUTHORITY TO OVERRULE

What kind of choices or decisions do you make independently and how often do these decisions occur? INDEPENDENT CHOICES/DECISIONS FREQUENCY

Does your job exist primarily for decision-making and policy establishment or primarily for implementation of policies and procedures? Explain. Decision-making & policy establishment Implementation of policies & procedures

Indiana State Personnel Department Division of Organizational Design & Development

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Do you supervise, provide leadership or coordinate the work of other employees on a permanent basis? If yes, then list the position title(s) and number of employees you supervise, direct or lead. Yes No JOB TITLE NUMBER OF EMPLOYEES

Do you conduct performance evaluations for those employees? Yes No

Do you sign these performance evaluations? Yes No

Do you approve leave requests? Yes No

Do you independently administer discipline to subordinate staff? Yes No

Briefly state the nature of your supervisory responsibility.

Who reviews your work; how often and for what purpose? Please indicate the class title of the individual(s) who reviews your work. WHO REVIEWS WORK FREQUENCY PURPOSE CLASS TITLE OF REVIEWER

Indiana State Personnel Department Division of Organizational Design & Development

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What types of technical or administrative instructions are provided to you? Please provide examples of each type of instruction. INSTRUCTIONS EXAMPLES

Please indicate the name and class title (if different than your supervisor) of the individual who provides instruction explained in the above question and how often instruction is provided. NAME/CLASS TITLE FREQUENCY

Which statement best describes the likely consequences of an error in doing your work? Please give examples of significant errors which could be made in your job and indicate the consequences such as delays, financial loss, effect on others, disruption or delay of service. An error would have little or no direct consequences on others. I could correct it myself. Explain:

An activity involving others could be delayed or an error would result in minor loss of resource. Explain:

Others could suffer damages or some physical/psychological discomfort; or an error would result in significant loss of time or resource. Explain:

Others could suffer significant physical/psychological harm; probable errors could involve considerable expenditures of time or resource or significant embarrassment within the organization. Explain:

Others could suffer permanent physical/psychological impairment; probable errors could involve major expenditure of time or resource or cause severe embarrassment with in the organization. Explain:

Indiana State Personnel Department Division of Organizational Design & Development

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Is it possible that the individual that reviews your work would not detect this error? If yes, please explain. Yes No

Are you responsible for the health, safety or well being of others? If yes, explain. Yes No

Are you accountable for the custody of money, securities, property or other items of special value? If yes, explain. Yes No

Indiana State Personnel Department Division of Organizational Design & Development

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PERSONAL WORK RELATIONSHIPS: In the space provided below, place a check in the "contact" column to indicate those individuals/groups with whom you must communicate verbally or in writing in order to complete your job assignments. Then, indicate the frequency and purpose of the communication. Exclude your supervisor. CONTACT Example: Vendors FREQUENCY Example: Daily Daily Weekly Monthly PURPOSE Example: To discuss problems with service and coordinate payment of account.

Section Co-workers

Other employees in agency

Daily Weekly Monthly

Other local, state, and federal employees (please explain)

Daily Weekly Monthly

Local, state, and federal officials (please explain)

Daily Weekly Monthly

Patients, residents or offenders

Daily Weekly Monthly

Public

Daily Weekly Monthly

Others (please explain) Daily Weekly Monthly

Indiana State Personnel Department Division of Organizational Design & Development

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WORK ENVIRONMENT/PHYSICAL EFFORT What percentage of your overall work time is spent in the following: (must total 100%) LOCATION Office Laboratory Outdoors Hospital and/or clinical setting Vehicle (specify) Example: patrol car Are you required to wear protective clothing or gear to perform any of your duties? If yes, please specify in the chart below. CLOTHING Example: safety goggles PURPOSE Example: protect eyes WHICH OF YOUR DUTIES REQUIRE THIS? Example: operating gas powered weed trimmer % OF WORK TIME

Please state any hazards or unfavorable conditions in your work environment. CONDITION Example: exposure to hazardous materials or extreme weather conditions. FREQUENCY OF EXPOSURE

Please list any special regulations or precautions, if applicable, which must be observed in performing routine duties. SPECIAL REGULATIONS OR PRECAUTIONS Example: Laboratory safety standards

Indicate the duties, which require greater than normal:
Indiana State Personnel Department Division of Organizational Design & Development

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ITEM Vision Hearing Color Perception Physical Strength Manual Dexterity Stamina

DUTY REQUIRED

What percentage of time do you spend doing the following while performing your duties? (Must total 100%) ITEM % OF TIME Sitting and/or walking at will Sitting in a restrictive position Standing Crouching or stooping Kneeling or stooping Climbing and/or balancing Lifting or carrying If you are required to perform lifting, please check the approximate weight of the objects you most frequently lift. Up to 10 lbs. occasionally Up to 20 lbs. occasionally and/or up to 10 lbs frequently 20 - 50 lbs. occasionally and/or 10 - 25 lbs frequently, and/or up to 10 lbs constantly 50 - 100 lbs occasionally and/or 25 - 50 lbs frequently, and/or 10 - 20 lbs constantly In excess of 100 lbs. occasionally and/or in excess of 50 lbs frequently, and/or in excess of 20 lbs constantly

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CERTIFICATION
I certify that the responses to all questions are complete and accurate to the best of my knowledge.

(Signature of Incumbent)

(Date)

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SUPERVISOR COMMENTS

SUPERVISOR'S SIGNATURE I have read the content of this questionnaire. I am aware that I am responsible for the accuracy and content provided in this document. Any additions or modifications made by me were discussed with the incumbent and are listed in the comments sections above.

(Signature of Supervisor)

(Date)

Indiana State Personnel Department Division of Organizational Design & Development

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