RETURN TO WORK PROGRAM TRANSITIONAL WORK ASSIGNMENT

Transcription

1 TITLE TWA Number Blank Form Office Sales Materials 1 Sales Assistant 2 Telephone Assistant 3 File Purge 4 Counting Money 5 New Employee Orientation 6 Observations / Inspections / Quality Assurance Conduct Behavior Safety Observations 7 Conduct Driver Safety Check Ride 8 Conduct Plant Safety Inspection 9 Conduct Periodic Accident Claims Analysis 10 Quality Assurance - Routes 11 Quality Inventory Checker - Warehouse 12 Janitorial (Inside and Outside) Janitorial 13 General Cleaning 14 Warehouse Clean Up 15 Yard Clean up and Check 16 Trailer Cleaner 17 Dock/Apron Cleaner 18 Sit Down Sweeper 19 Maintenance / Warehouse / Production Painter (Helper) 20 Groundskeeper Assistant 21 Modified Forklift Operator 22 Returns: Freezer and Warehouse 23 Food Service Assistant Cashier Duties 24 Food Service Assistant 25 Security Attendant 26 Rev. 9/22/2010

2 Assignment: Location: (Blank Form) Available Hours: Sit: Stand: Walk: Bend: Kneel/Squat: Climb Stairs: Crawling: Overhead Reach: Grasp: Push/Pull: Fine Manipulation: Lift: Carry: Push: Pull: Miscellaneous Typing/Keyboard Vehicle Operation: Exposure to Water:

3 Assignment: Sales Materials Location: Available Hours: 4-5 Assignment is to insert promotional materials into sales brochure. Assemble miscellaneous flyers, labels or other lightweight paper items for use by sales staff, merchandisers, etc. Self-paced activity, employee can change positions as needed (sit, stand, etc.). No fine manipulations required, occasional grasp and open to insert materials. COMMENTS: (Captive Member) is flexible with hours and work activities within the employee s restrictions and capabilities. Assignments can be combined to create up to an eight-hour schedule. Weights and measures are an average based on the work locations and equipment observed during the defined tasks. NOTE: On terms of an eight-hour work day: Limited (0-1 hour), Occasionally (1-2 hours) equals 1% to 25%, Frequently (3-4 hours) equals 26% to 50%, Repeatedly (5-6 hours) equals 51% to 75%, and Continuously (7+ hours) equals 76% Sit: Frequently Grasp: Occasionally Stand: Frequently Push/Pull: Walk: 14 steps to display area, two times per shift. Limited Fine Manipulation: Bend: Non-repetitive at waist Lift: Promotional Material 0-5 Limited Kneel/Squat: Carry: Promotional Material 0-5 Limited Climb Stairs: Push: Crawling: Pull: Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: Exposure to Water: Can bring materials to work area to eliminate any lifting.

4 Assignment: Sales Assistant Location: Available Hours: 8 Taking orders and working with customers over the telephone. Self-paced activity, employee has the option to take rest breaks as indicated. Employee can sit or stand, use headset if requested. COMMENTS: (Captive Member) is flexible with hours and work activities within the employee s restrictions and capabilities. Assignments can be combined to create up to an eight-hour schedule. Weights and measures are an average based on the work locations and equipment observed during the defined tasks. NOTE: On terms of an eight-hour work day: Limited (0-1 hour), Occasionally (1-2 hours) equals 1% to 25%, Frequently (3-4 hours) equals 26% to 50%, Repeatedly (5-6 hours) equals 51% to 75%, and Continuously (7+ hours) equals 76% Sit: Can alternate with standing Frequently Grasp: Repetitive use of hands with telephone keypad and computer. Frequently Stand: Can alternate with sitting Frequently Push/Pull: Walk: Very short distances. Occasionally Fine Manipulation: Bend: Lift: Lifting Paperwork 0-5 Limited Kneel/Squat: Carry: Lifting Paperwork 0-5 Limited Climb Stairs: Push: Crawling: Pull: Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: Some computer keying Occasionally Exposure to Water:

5 Assignment: Telephone Assistant Location: Office Available Hours: 8:00 am 9:00 am 2:30 pm 4:30 pm 1-2 The tasks associated with this transitional work assignment involve telephone response to customer calls, explain location of customer s freight, answer and route calls in office. Perform light clerical. (Check computer screen for information). Sit: To use phone and reference computer Occasionally Grasp: Phone Occasionally screen Stand: As necessary for breaks Limited Push/Pull: Walk: To and from area Limited Fine Manipulation: Select keys, phone, pencil Occasionally Bend: Lift: Kneel/Squat: Carry: Climb Stairs: Push: Crawling: Pull: Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: Very minimal use of keyboard to change Limited Exposure to Water: screens

6 Assignment: File Purge Location: Office Available Hours: 2 3 days/month or 3-4 hours/day for several days Flexible The tasks associated with this transitional work assignment involve cleaning file drawers of information and materials that have met retention limits (periods of 6 months to several years). Involves pulling, removing files with old dates and placing in boxes on a table or desk. File cabinet drawers are 12 x 54. Secretary or Manager will scan for accuracy. Sit: As necessary for breaks or to work in Frequently Grasp: Files, paper, drawer handle Frequently lower drawers Stand: As necessary Occasionally Push/Pull: File drawers up to 15 lbs. 20 lbs. Frequently Walk: To and from work area Occasionally Fine Manipulation: Bend: Prefer kneel/squat to bending Limited Lift: Files <5 lbs. Occasionally Kneel/Squat: Limited Carry: Files <5 lbs. Occasionally Climb Stairs: Limited Push: File drawer < 20 lbs. Frequently Crawling: Pull: File drawer < 20 lbs. Frequently Overhead Reach: Forward Reach Limited Miscellaneous Typing/Keyboard Vehicle Operation: Exposure to Water: Other employees can lift filled file boxes.

7 Assignment: Counting Money Location: Available Hours: 2 Hours Pour money from machines into bags, sort coins, wrap coins and total coin amount. Self-paced activity, employee can modify to meet restrictions. Can sit and take standing or other rest breaks as needed. COMMENTS: (Captive Member) is flexible with hours and work activities within the employee s restrictions and capabilities. Assignments can be combined to create up to an eight-hour schedule. Weights and measures are an average based on the work locations and equipment observed during the defined tasks. Sit: Job can be done sitting/standing Occasionally Grasp: Ability to alternate hands Limited Stand: Position can be performed Limited Push/Pull: sitting/standing Walk: Short distances from machine to work area, approximately 50 ft. Occasionally Fine Manipulation: Coin rolls filled and closed Limited Bend: Limited bending to collect money Limited Lift: Carry money bags lbs. Frequently from machine Kneel/Squat: Carry: Carry money bags lbs. Frequently Climb Stairs: Push: Open/close machine doors 1 10 lbs. Limited Crawling: Pull: Open/close machine doors 1 10 lbs. Limited Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: Exposure to Water: Can use small cart to transport coin bags if needed.

8 Assignment: New Employee Orientation Location: Available Hours: 1 Introduce employees to co-workers, take ID photo, and show facility. Employee has the ability to take rest break as needed. COMMENTS: (Captive Member) is flexible with hours and work activities within the employee s restrictions and capabilities. Assignments can be combined to create up to an eight-hour schedule. Weights and measures are an average based on the work locations and equipment observed during the defined tasks. NOTE: On terms of an eight-hour work day: Limited (0-1 hour), Occasionally (1-2 hours) equals 1% to 25%, Frequently (3-4 hours) equals 26% to 50%, Repeatedly (5-6 hours) equals 51% to 75%, and Continuously (7+ hours) equals 76% Sit: Brief discussions Occasionally Grasp: Non-repetitive, very limited use Limited Stand: Brief, during facility tour Occasionally Push/Pull: Walk: Tour of facility Occasionally Fine Manipulation: Bend: Lift: Camera, Film, etc. 0-5 Limited Kneel/Squat: Carry: Miscellaneous papers 0-5 Limited Climb Stairs: Push: Opening Doors 0-5 Limited Crawling: Pull: Opening Doors 0-5 Limited Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: Exposure to Water:

9 Assignment: Conduct Behavior Safety Observations Location: Human Resources Available Hours: 1-2 Walk around production, distribution, and office areas observing other employees performing their jobs. Employee is given a critical task(s) or activity(s) to observe. Walks to area, stands and makes observations of employees performing those pre-selected target activities and/or verify that tasks are being performed in prescribed manner according to standard operating procedures or Job Safety Analyses. Documents all observations on a form. May work alone or as member of team. Can take break as needed. Sit: During task time (1 2 Hours) Minimal or as Grasp: Light grasp on pen/pencil when writing. As needed needed. Stand: During task time (1 2 hours) Continually Push/Pull: Walk: During task time. Frequently or as needed. Fine Manipulation: Writing Limited Bend: Lift: Kneel/Squat: Carry: Clipboard, if used < l lb. Task time Climb Stairs: No ladder climbing; may need to use stairs to access second floor. Minimal or as needed. Crawling: Pull: Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: Exposure to Water: Normal to this facility Normal for facility Push:

10 Assignment: Conduct Driver Safety Check Ride Location: Human Resources Available Hours: 1-8 Ride as passenger with Route Truck Driver for 1 to 8 hours per day. Conducts driver safety checks; observing driving practices and using a provided checklist. Also makes notations on driver conformance to safe driving practices. Reports to Fleet Manager. Can also do PACE Driver Evaluation rides if trained on PACE concepts. Sit: During task time as passenger; wear seat As needed or up Grasp: Light grasp on pen/pencil when writing. As needed belt to 8 hours Stand: During task time Minimal to none Push/Pull: Walk: During task time Minimal to none Fine Manipulation: Writing Limited Bend: Limited to none Lift: None <5 lbs. Limited Kneel/Squat: None Carry: <2 lbs. Minimal Climb Stairs: Must get in/out of vehicle Minimal; as Push: None needed Crawling: Pull: None Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: (passenger only) Exposure to Water: Air conditioned cab Minimal Normal

11 Assignment: Conduct Plant Safety Inspection Location: Human Resources Available Hours: 1-2 Walk around production, warehouse/distribution and office areas on the lookout for unsafe conditions or other types of physical hazards. May work alone or as a member of a team. Document hazards on form. Can sit/take break as needed. Sit: During Task Time Minimal to None Grasp: Light grasp on pen/pencil when writing As needed Stand: During Task Time Occasionally Push/Pull: None Walk: During Task Time Occasionally Fine Manipulation: Writing Limited Bend: Limited to None Lift: No None Kneel/Squat: None Carry: Clipboard, if used <1 lb. Minimal Climb Stairs: Minimal as Push: needed Crawling: None Pull: Overhead Reach: None Miscellaneous Typing/Keyboard Vehicle Operation: Exposure to Water:

12 Assignment: Conduct Periodic Accident Claims Analysis Location: Human Resources Available Hours: 1-4 Summarize accident data into prescribed categories for meaningful analysis. The extent of analysis will be partly determined on employee s computer skills and knowledge of software programs such as Excel; otherwise, limited to data gathering and tabular summarization. Sit: During task time Frequently Grasp: Light grasp on pen/pencil when writing As needed Stand: During task time As needed Push/Pull: Walk: During task time As needed Fine Manipulation: Writing, keyboard input Minimal Bend: Lift: Kneel/Squat: Carry: Climb Stairs: Push: Crawling: Pull: Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: Can type or write Limited

13 Assignment: Quality Assurance Location: Available Hours: 8-10 Ride with driver; talk with each customer that is on that route. Get feedback from customer about service and operation times. This is slow-paced activity and a lumbar support can be provided when riding in truck. Fill out feedback report if requested. Sit: Repeatedly Grasp: Must be able to write documentation. Limited Stand: Frequently Push/Pull: Must be able to pull partial body Frequently weight up to climb into cab. Walk: Occasionally Fine Manipulation: Bend: Very Limited bending, only when getting Very Limited Lift: Clipboard with notes 0 5 lbs. Frequently in/out of cab. Kneel/Squat: Carry: Clipboard with notes 0 5 lbs. Frequently Climb Stairs: Must climb three steps Push: Crawling: Pull: Must be able to pull partial body weight up to climb into cab. Frequently Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: Exposure to Water:

14 Assignment: Quality Inventory Checker - Warehouse Location: Warehouse Available Hours: 1 st Shift Warehouse Manager 1-8 The tasks associated with this temporary transitional assignment involve general documentation of expiration dates on products stored in the warehouse. Using a pencil the expiration dates of all products are listed on the product expiration forms. The paperwork required is form filling, fine manipulation or writing skill is not necessary. This task is flexible to either stand or sit while documenting and breaks can be taken as needed. Note: Other warehouse personnel are present and able to assist with moving products upon request. Climbing or lifting products can be accomodated if not within the individuals physical restrictions. COMMENTS: Captive Member can be flexible with hours and work within the injured employee s restrictions and limitations. If on occasion there is any lifting of over 25 lbs. there are other staff near the area that can assist as needed. 4 hours) equals 26% to 50%, Repeatedly (5-6 hours) equals 51% to 75%, and Continuously (7+ hours) equals 76% to 100%. Sit: as desired Frequently Grasp: papers, pens, clipboard Occasionally/ Repeatedly Stand: as desired Frequently Push/Pull: NA Walk: to and from product areas Limited Fine Manipulation: NA Bend: Limited Lift: papers < 2 Limited/ Frequently Kneel/Squat: Limited Carry: NA Climb Stairs: Limited Push: NA Crawling: NA Pull: NA Overhead Reach: Limited Miscellaneous Typing/Keyboard Vehicle Operation: NA keyboard and mouse use Exposure to Water: NA NA NA NA

15 Assignment: Janitorial Location: Available Hours: 1-2 Employee can sweep using push or standard broom, pick up trash (0 5 lbs) and throw garbage away daily into dumpster. Self-paced, employee permitted to break as necessary. Employee can use trash grabber to pick up paper trash. COMMENTS: (Captive Member) is flexible with hours and work activities within the employee s restrictions and capabilities. Assignments can be combined to create up to an eight-hour schedule. Weights and measures are an average based on the work locations and equipment observed during the defined tasks. Sit: Occasionally Grasp: Use of arm/hands needed to pick up Occasionally and place trash in dumpster. Stand: Occasionally Push/Pull: Broom Occasionally Walk: Occasionally Fine Manipulation: Bend: Limited to picking up trash containers. Limited Lift: This can be modified as needed. Employee has option to lighten load lbs. Limited Kneel/Squat: Carry: This can be modified as 1 10 lbs. Limited needed. Employee has option to lighten load. Climb Stairs: Occasionally Occasionally Push: Broom if able 0 5 lbs. Limited Crawling: Pull: Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: Exposure to Water: Gloves recommended Occasionally

16 Assignment: General Cleaning Location: Available Hours: 1-5 Includes mopping, sweeping and other general cleaning. Self-paced task, rest breaks can be taken as needed. Sit: Occasionally Grasp: Can alternate hands Frequently Stand: Frequently Push/Pull: Occasionally Walk: Short distances within a given area Frequently Fine Manipulation: Bend: Required limited bending at waist and Limited Lift: The heaviest item listed is a 1 25 lbs. Limited knees mop with water. A smaller mop can be substituted. Kneel/Squat: Limited Carry: Mop, Water 1 25 lbs. Limited Climb Stairs: Push: Pushing mop or broom, 1 25 lbs. Occasionally wiping down eating area. Crawling: Pull: Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: Exposure to Water: Gloves recommended Occasionally

17 Assignment: Warehouse Clean-up Location: Available Hours: 1-3 Requires the ability to operate a walkie; picks up boxes, plastics and broken boards from the aisles and pallets. Task can be modified if necessary. Self-paced activity, rest breaks can be given if needed. Sit: During breaks and rest periods. Very Limited Grasp: Can be done altering left/right hands Occasionally Stand: Up to 50% of shift, riding the walkie Occasionally Push/Pull: Only to push boxed plastics into Very Limited from one aisle to another. dumpster. Walk: Occasionally Fine Manipulation: Bend: Be able to bend knees to pick up items off the floor. Kneel/Squat: Climb Stairs: Must step up onto and off walkie. Limited Limited Lift: Clean-up includes picking up boxes, plastics and pallets. Carry: Clean-up includes picking up boxes, plastics and pallets. Push: Very limited, only to push boxed plastics into dumpster lbs. Limited 0 60 lbs. Limited 0 60 lbs. Limited Crawling: Pull: Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: Walkie Pallet Jack Occasionally Exposure to Water:

18 Assignment: Yard Clean up and Check Location: Yard Available Hours: 1-2 The tasks associated with this transitional work assignment involve walking around the yard during early and late daylight hours, checking fence for holes and yard for debris. Pick up debris, papers, etc., as necessary and report to supervisor any problems or security issues or lighting malfunctions. Sit: Grasp: Grabber and bag to pick up debris Occasionally Stand: Push/Pull: Walk: Walking around yard Limited Fine Manipulation: Bend: prefer kneel/squat to bending Limited Lift: bag of debris <10 lbs. Occasionally Kneel/Squat: kneel or squat to pick up debris Limited Carry: bag of debris < 10 lbs. Occasionally Climb Stairs: Push: Crawling: Pull: Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: Exposure to Water: Occasionally Gloves recommended Occasionally Can use trash grabber to reduce bending and grasping.

19 Assignment: Trailer Cleaner Location: Dock Available Hours: Day or Night Shift The task associated with this transitional work assignment involves sweeping out trailers before loading and after unloading, as necessary. Use shovel or a dust pan, sweep debris into shovel or dust pan and empty into waste bins on dock bay. Sit: Grasp: broom, shovel Frequently Stand: Waiting for Trailer Limited Push/Pull: broom, shovel Frequently Walk: While cleaning Frequently Fine Manipulation: Bend: Limited Lift: shovel, broom 0 15 lbs. Occasionally Kneel/Squat: To pick up dust pan Occasionally Carry: to/from trailer 0 15 lbs. Occasionally Climb Stairs: Push: broom lbs. Frequently Crawling: Pull: broom lbs. Frequently Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: Exposure to Water: Limited Limited Gloves recommended Occasionally

20 Assignment: Dock/Apron Cleaner Location: Dock Available Hours: Days and Nights 2 to 6 The tasks associated with this transitional work assignment involve sweeping and raking debris that accumulates on dock and on ground below the dock (apron) within several feet of the dock, uses dust pan or shovel to lift debris and place in trash barrel. Occasional bending to pick up dust pan. Requires walking up and down a ramp from 4-1/2 inches to ground level. Sit: As needed for breaks Limited Grasp: Broom, dust pan, rake Repeatedly Stand: Occasionally Push/Pull: Broom, rake Repeatedly Walk: Repeatedly Fine Manipulation: Bend: Limited Lift: 5 6 lbs. Frequently Kneel/Squat: Crouch to use dust pan Limited Carry: Debris to trash < 10 lbs. Frequently Climb Stairs/Ladder: Push: Broom/rake 10 lbs. Frequently Crawling: Pull: Broom/rake 10 lbs. Frequently Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: Exposure to Water: Open air by dock Frequently Gloves recommended

21 Assignment: Sit Down Sweeper Location: Available Hours: 4:00 PM 5:00 PM 1-2 This task associated with this transitional work assignment involves operating a sit-down sweeper through the warehouse. Training will be provided to ensure safe operation of the sweeper. Sit: (1 Hour usually) Occasionally Grasp: Must utilize arm/hand to turn steering Limited wheel. Stand: Limited Push/Pull: Walk: Limited Fine Manipulation: Bend: Lift: Kneel/Squat: Carry: Climb Stairs: Push: 0 5 lbs. to turn 0 5 lbs. Limited steering on sweeper Crawling: Pull: Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: Exposure to Water:

22 Assignment: Painter (Helper) Location: Dock, Office, Yard Available Hours: Day Shift 2-3 hours, 3 day/month The tasks associated with this transitional work assignment involve painting lines on dock areas, parking spaces, bollards (safety poles) or other areas of the facility; grasping, reaching, use of dominant upper extremity. Rollerchair can be provided for employee to sit in as he/she paints lines and low objects. Sit: Sit in roller chair as necessary alternate Occasionally Grasp: Chair 2-5 lbs. Occasionally with standing. Stand: Stand as necessary Occasionally Push/Pull: Chair 2 5 lbs. Limited Walk: Walk to and from dock or building Limited Fine Manipulation: Bend: Prefer kneel/squat to bending Limited Lift: Paint can or container 1 10 lbs. Occasionally Kneel/Squat: to pick up debris Carry: Paint can or container 1 10 lbs. Occasionally Climb Stairs: Possibly a few to office Push: Stool/chair on wheels 2 5 lbs. Occasionally Crawling: Pull: Stool/chair on wheels 2 5 lbs. Occasionally Overhead Reach: Possibly on rare occasion Occasionally Miscellaneous Typing/Keyboard Vehicle Operation: Exposure to Water: Clean up Limited Paint Occasionally Possible open air dock Occasionally Special Clothing/Equipment: Paint brush Occasionally

23 Assignment: Groundskeeper Assistant Location: Maintenance Available Hours: Day Shift - Spring, Summer, Early Fall 1 2 hrs/week The tasks associated with this transitional work assignment involve sweeping walkways, watering plants on grounds. Sit: Grasp: Broom/rake/hose Limited Stand: For breaks Limited Push/Pull: Broom/rake Occasionally Walk: While sweeping/watering Limited Fine Manipulation: Bend: Prefer kneel/squat to bending Limited Lift: Broom/hose < 10 lbs. Limited Kneel/Squat: To pick up debris Limited Carry: Broom/hose < 10 lbs. Limited Climb Stairs/Ladder: Possibly a few to office Limited Push: Broom/hose < 10 lbs. Limited Crawling: Pull: Broom/hose < 10 lbs. Limited Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: Exposure to Water: From garden hose Occasionally Outdoors Occasionally

24 Assignment: Modified Forklift Operator Location: Dock Available Hours: All Shifts 2 to 5 The tasks associated with this transitional work assignment involve using a forklift. No lifting of product is involved. Employee uses 3-point contact to climb onto forklift (20 in. step). Requires sitting on padded seat, using foot pedals and hand levers that are power assist and require 15 in. forward/backward motion and approximately 5 lb. 6 lb. pressure. Left hand brake takes approximately 15 lb. 25 lb. pressure. Breaks can be taken hourly or less frequently. Steering wheel at waist level in almost horizontal position requires approximately 15 lbs. push/pull. Sit: padded seat Repeatedly Grasp: Wheel, levers Repeatedly Stand: for break Limited Push/Pull: Repeatedly levers and wheel Repeatedly Walk: to and from lift Limited Fine Manipulation: Bend: Prefer kneel/squat to bending Limited Lift: Kneel/Squat: Carry: Climb Stairs/Ladder: One step into forklift Limited Push: Foot pedals 5 25 lbs. Frequently Crawling: Pull: Hand levers 5 25 lbs. Frequently Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: Forklift Continuously Exposure to Water: Roofed open air dock Continuously

25 Assignment: Returns: Freezer and Warehouse Location: Available Hours: 2-4 8:00 AM 12:00 Noon This task involves removing stock from trucks and restocking. Merchandise that comes back on trucks must be placed back in slots. Self-paced activity. May take rest breaks as indicated. Requires lifting, possible use of pallet jack or cart to transport goods. COMMENTS: (Captive Member) is flexible with hours and work activities within the employee s restrictions and capabilities. Assignments can be combined to create up to an eight-hour schedule. Weights and measures are an average based on the work locations and equipment observed during the defined tasks. Sit: Limited Grasp: Must utilize both hands with this task. Frequently Stand: Continuously Push/Pull: May use cart Limited Walk: Limited Fine Manipulation: Bend: Very Limited Lift: Can be modified based upon 0 50 lbs. Limited lifting restrictions. Kneel/Squat: Carry: Can be modified based upon 0 50 lbs. Frequently lifting restriction. Climb Stairs: Not required. Can use pallet jack Push: To push some merchandise to 0 10 lbs. Limited for higher to reach racks. back of rack. Crawling: Pull: To push some merchandise to 0 10 lbs. Limited back of rack. Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: Exposure to Water:

26 Assignment: Food Service Assistant - Cashier Duties Location: Cafeteria Available Hours: First Shift Cafeteria Manager 1 4 (Part Time) The tasks associated with this temporary transitional assignment involve primarily working as a cashier in the cafeteria. Employee would be required to look at the items the customer would like to purchase and key the items into the cash register, collect the money and make change as needed. Repetitive motion such as scanning items is not required. The employee can sit on a stool while ringing up the orders. Employee would be required to walk from the parking lot to the cafeteria and to and from breaks. Sit: Mainly or as desired Frequently Grasp: Handle money Frequently Stand: As Desired Limited Push/Pull: Walk: To and from work areas and on breaks Limited Fine Manipulation: Bend: Lift: Money <1 Kneel/Squat: Carry: Climb Stairs: Push: Crawling: Pull: Overhead Reach: Miscellaneous Typing/Keyboard Vehicle Operation: Exposure to Water:

27 Assignment: Food Service Assistant Location: Cafeteria Available Hours: 2nd Shift Cafeteria Manager 1-8 The tasks associated with this temporary transitional assignment involve primarily working in the deli station and preparing approximately 10 sandwiches between 2pm and 6pm employee may sit on a stool or stand. Additional housekeeping duties are to clean and stock the service area as needed, tidy and stock the restrooms, and assist the cook with drying large pots and pans while sitting on a stool or standing,. 4 hours) equals 26% to 50%, Repeatedly (5-6 hours) equals 51% to 75%, and Continuously (7+ hours) equals 76% Sit: mainly or as desired Frequently Grasp: sandwich items, supplies Frequently Stand: as desired Occasionally Push/Pull: NA Walk: to and from work areas and on breaks Limited Fine Manipulation: NA Bend: NA Lift: supplies < 15 Limited Kneel/Squat: NA Carry: papers <15 Limited Climb Stairs: NA Push: NA Crawling: NA Pull: NA Overhead Reach: NA Miscellaneous Typing/Keyboard Vehicle Operation: NA Exposure to Water: NA Cleaning supplies NA NA

28 Assignment: Security Attendant Location: Security Office Available Hours: 1 st Shift Area Supervisor 1-8 The tasks associated with this temporary transitional assignment involve primarily sitting in the security office area and operating the security gate, monitoring surveillance cameras and monitoring the company fuel tanks. Administrative duties are also performed such as issuing vehicle keys, checking paperwork for out of date products, separating route cards for driver s daily assignments, and completing reports. COMMENTS: Captive Member can be flexible with hours and work within the injured employee s restrictions and limitations. If on occasion there is any lifting of over 25 lbs. there are other staff near the area that can assist as needed. Sit: mainly Repeatedly Grasp: papers, pens, files Frequently Stand: as desired Limited Push/Pull: NA Walk: to and from work areas and on breaks Limited Fine Manipulation: NA Bend: Limited Lift: papers < 2 Frequently Kneel/Squat: NA Carry: papers <1 Minimal Climb Stairs: NA Push: NA Crawling: NA Pull: NA Overhead Reach: NA Miscellaneous Typing/Keyboard Vehicle Operation: NA Exposure to Water: NA NA NA NA