survey questionnaire page ('Mark your response ...')

Summary

A questionnaire about the respondent's current job, beginning with instructions to mark each response with a check mark, an "X," or a completely filled circle. Question 1 asks how frequently the job requires face-to-face discussions, public speaking, telephone conversation, e-mail and written letters and memos. Later questions ask about contact with others, work environments, physical closeness to other people, exposure to noise, temperature, radiation, diseases or infection and hazardous equipment, and time spent sitting, standing or walking. Further items ask about the seriousness of mistakes, freedom to make decisions without supervision, strict deadlines and schedule regularity. Question 25 asks how many hours the respondent works in a typical week: less than 40 hours, 40 hours or more than 40 hours.

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Issuer: Source documents
Document type: Questionnaire beginning “How frequently does your current job require each of the following items?”
Case: Questionnaire beginning “How frequently does your current job require each of the following items?”

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“survey questionnaire page ('Mark your response ...').” Original at www.onetcenter.org. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/weathering-the-storm-who-can-access-credit-in-a-pandemic/, SHA-256 64530c3425d8f5e9b8038c8f5940e1ca5e48278b48a7ad760eac1310f601759d.

Full text

Mark your response by placing a check mark, an “X,” or completely filling in the circle:
✓ or X or

1. How frequently does your current job require each of the following items?
Once a year Once a month
or more but or more but Once a week
not every not every or more but
Never month week not every day Every day
a. Face-to-face
discussions with
individuals and
within teams
b. Public speaking (one
speaker with an
audience)
c. Telephone
conversation

d. E-mail

e. Written letters and
memos

2. How much contact with others (by telephone, face-to-face, or otherwise) is required to perform your
current job?
No contact with others
Occasional contact with others
Contact with others about half the time
Contact with others most of the time
Constant contact with others

3. In your current job, how important are each of the following interactions?
Not
important Fairly Very Extremely
at all important Important important important
a. Work with or contribute to a work
group or team
b. Deal with external customers (as in
retail sales) or the public in general
(as in police work)
c. Coordinate or lead others in
accomplishing work activities (not as
a supervisor or team leader)
4. In your current job, how responsible are you for the following?
No Limited Moderate High Very high
responsibility responsibility responsibility responsibility responsibility
a. Health and safety of
other workers
b. Work outcomes and
results of other workers

5. How frequently do the following occur in your current job?
Once a Once a
Once a year month or week or
or more but more but more but
not every not every not every
Never month week day Every day
a. Conflict situations

b. Dealing with unpleasant, angry, or
discourteous people

c. Dealing with violent or physically
aggressive people

6. How often does your current job require you to work in the following environments?
Once a Once a
Once a year month or week or
or more but more but more but
not every not every not every
Never month week day Every day
a. Indoors in an environmentally
controlled environment (like a
warehouse with air conditioning)
b. In an environment that is not
environmentally controlled (like a
warehouse without air
conditioning)
c. Outdoors, exposed to all weather
conditions
d. Outdoors, under cover (like in an
open shed)
e. In an open vehicle or operating
equipment (like a tractor)
f. In a closed vehicle or operate
enclosed equipment (like a car)
7. How physically close to other people are you when you perform your current job?
I don’t work near other people (beyond 100 ft.)
I work with others but not closely (e.g., private office)
Slightly close (e.g., shared office)
Moderately close (at arm’s length)
Very close (nearly touching)

8. In your current job, how often are you exposed to the following conditions?

Once a year Once a
or more but month or Once a week
not every more but not or more but
Never month every week not every day Every day

a. Sounds and noise levels
that are distracting and
uncomfortable

b. Very hot (above 90° F)
or very cold (under 32°
F) temperatures

c. Extremely bright or
inadequate lighting
conditions

d. Contaminants (such as
pollutants, gases, dust,
or odors)

e. Cramped work space
that requires getting
into awkward positions

f. Whole body vibration
(like operating a
jackhammer or earth
moving equipment)
9. How often does your current job require that you be exposed to the following conditions?
Once a Once a
Once a year month or week or
or more but more but more
not every not every but not
Never month week every day Every day

a. Radiation

b. Diseases or infection—This can
happen with workers in patient
care, laboratory work, sanitation
control, etc.

c. High places—This can happen
for workers who work on poles,
scaffolding, catwalks, or ladders
longer than 8 feet in length

d. Hazardous conditions—This can
happen when working with
high-voltage electricity,
flammable material, explosives,
or chemicals. Do not include
working with hazardous
equipment

e. Hazardous equipment—This
includes working with saws,
close to machinery with exposed
moving parts, or working near
vehicular traffic (but not
including driving a vehicle)

f. Minor burns, cuts, bites, or
stings
10. How much time in your current job do you spend doing each of the following?
Less than More than Continually
half the About half half the or almost
Never time the time time continually
a. Sitting

b. Standing

c. Climbing ladders, scaffolds,
poles, etc.

d. Walking or running

e. Kneeling, crouching, stooping, or
crawling

11. How much time in your current job do you spend doing each of the following?
Less than More than Continually
half the About half half the or almost
Never time the time time continually
a. Keeping or regaining your balance
b. Using your hands to handle,
control, or feel objects, tools, or
controls
c. Bending or twisting your body

d. Making repetitive motions

12. In your current job, how often do you wear each of the following?
Once a year Once a Once a
or more month or week or
but not more but more but
every not every not every
Never month week day Every day
a. Common protective or safety
equipment, such as safety shoes,
glasses, gloves, hearing protection,
hard hats, or life-jackets

b. Specialized protective or safety
equipment, such as breathing
apparatus, safety harness, full
protection suits, or radiation
protection
13. How serious a mistake can you make on your current job (one you can’t easily correct)?
Not serious at all
Fairly serious
Serious
Very serious
Extremely serious

14. In your current job, what results do your decisions usually have on other people or the image or
reputation or financial resources of your employer?
No results
Minor results
Moderate results
Important results
Very important results

15. In your current job, how often do your decisions affect other people or the image or reputation or
financial resources of your employer?
Never
Once a year or more but not every month
Once a month or more but not every week
Once a week or more but not every day
Every day

16. In your current job, how much freedom do you have to make decisions without supervision?
No freedom
Very little freedom
Limited freedom
Some freedom
A lot of freedom

17. How automated is your current job?
Not at all automated
Slightly automated
Moderately automated
Highly automated
Completely automated

18. How important to your current job is being very exact or highly accurate?
Not important at all
Fairly important
Important
Very important
Extremely important
19. How important to your current job are continuous, repetitive physical activities (like key entry) or
mental activities (like checking entries in a ledger)?
Not important at all
Fairly important
Important
Very important
Extremely important
20. How much freedom do you have to determine the tasks, priorities, or goals of your current job?
No freedom
Very little freedom
Limited freedom
Some freedom
A lot of freedom
21. How competitive is your current job?
Not at all competitive
Slightly competitive
Moderately competitive
Highly competitive
Extremely competitive
22. How often does your current job require you to meet strict deadlines?
Never
Once a year or more but not every month
Once a month or more but not every week
Once a week or more but not every day
Every day
23. How important to your current job is keeping a pace set by machinery or equipment?
Not important at all
Fairly important
Important
Very important
Extremely important
24. How regular is your work schedule at your current job?
Regular (established routine, set schedule)
Irregular (changes with weather conditions, production demands, or contract duration)
Seasonal (only during certain times of the year)
25. How many hours do you work in a typical week on your current job?
Less than 40 hours
40 hours
More than 40 hours

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