Job Analysis Questionnaire

Confidentiality statement: There are NO risks in participating in this research,

your results will be held in strict confidence, and will be displayed only in the
research results, no individual name or other information will be referenced.

Information

Your job title ______________________________

Your superior’s title ________________________
Department ______________________________
Hours worked ___________ am/pm to _______________ am/pm

Please briefly answer the following questions:

1. What is the general purpose of your job?

__________________________________________________________________

2. What was your last job? If it was in another organization, please name it.
__________________________________________________________________

3. To what job would you normally expect to be promoted?

__________________________________________________________________

4. Education: Please check the box that indicates the education requirements for the
job, not your own educational background:

 None
 High school diploma or equivalent
 2-year college certificate
 4-year college degree
 Education beyond undergraduate degree and/or professional license

Please indicate the education you had when you were placed on this job:__________

5. Experience – Please check the educational amount needed to perform your job:

 None  1 – 3 years
 Less than one month  3 – 5 years
 1 – 6 months  5 – 10 years
 6 months to 1 year  More than 10 years
6. Skills: Please list any skills required in the performance of your job:
____________________________________________________________________

7. Equipment: Does your work require the use of any equipment? Yes ____ No ____
If yes, please list the equipment and check whether you use it rarely, occasionally or
frequently:
Equipment Rarely Occasionally Frequently

(1) ____________________   
(2) ____________________   
(3) ____________________   

8. Physical demands: Please check all undesirable physical demands required on

your job and whether you are required to do so rarely, occasionally or frequently:

Rarely Occasionally Frequently

 Awkward or cramped   
positions
 Excessive working speeds   
 Handling heavy weights   
 Sitting/Standing for long   
periods of time
 Other __________________   

9. Emotional demands: Please check all undesirable emotional demands placed on

you by your job and whether they occur rarely, occasionally or frequently:

Rarely Occasionally Frequently

 Contact with general public   

 Close supervision   
 Working alone   
 Irregular activity schedules   
 Other   
10. Workplace location: Check the type of location of your job and if you consider it to
be unsatisfactory or satisfactory.
Unsatisfactory Satisfactory
 Outdoor  
 Indoor  
 Other _____________  

11. Physical surroundings: Please check whether you consider the following physical
conditions to be poor, fair, good or excellent.

Poor Fair Good Excellent

 Lighting    
 Ventilation    
 Air conditioning    
 Comfort of furnishings    

12. Environmental conditions: Please check the conditions under which you must
perform your job and whether they exist rarely, occasionally or frequently:
Rarely Occasionally Frequently
 Dust   
 Heat   
 Cold   
 Noise   
 Humidity   
 Other   

13. Describe briefly any undesirable Health and Safety factors under which you must
perform your job:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

Signature ________________________ Date _____________________