ذدà،±ل>‏ے =?‏ےےے:;<ےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےى¥ءa ّ؟\bjbjjعjع a°?b°?b°A ےےےےےے·8 8 ´´´´´Tےےےےک lش²\‚à¤„(„(„(„(_)ط7/´ë1\ف[ك[ك[ك[ك[ك[ك[$4`¶êb¶\i´G3_)_)G3G3\´´„(„(غl\u9u9u9G3R´„(´„(ف[u9G3ف[u9u9R^U79X„(ےےےے€iüا صےےےے™3•Vة[‚\0²\³V† c©3 c<9X9X c´MX|G3G3u9G3G3G3G3G3\\6بG3G3G3²\G3G3G3G3ےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےےے cG3G3G3G3G3G3G3G3G38 Bz: Employee Work Profile NORFOLK STATE UNIVERSITY/213 PART I – Position Identification Information1. Employee Name: 2. Position Number: 3. Role Title & Code: 4. Occupational Family & Career Group: 5. Working Title: 6. Federal SOC Title & Code7. EEO Code: 8. Pay Band: 9. Essential Position during emergencies: FORMCHECKBOX Yes FORMCHECKBOX No10. . Employee FLSA Status: FORMCHECKBOX Exempt FORMCHECKBOX Non-Exempt11. Level Indicator: FORMCHECKBOX Employee FORMCHECKBOX Supervisor FORMCHECKBOX Manager12. Number of Employees Directly Supervised: 13. Supervisor’s Position Number: 14. Supervisor’s Role Title: 15. Effective Date: October 25, 20_ _ – October 24, 20_ _PART II – Work Description & Performance Plan16. Organizational Objective: 17. Purpose of Position: 18. KSA’s and or Competencies required to successfully perform the work: 19. Education, Experience, and Licensure, Certification required for entry into position PREFERRED QUALIFICATIONS: %Time20. Core Responsibilities21. Measures for Core ResponsibilitiesPerformance Management (Required for supervisors only) Expectations are clear, well communicated, and relate to the goals and objectives of the department. Staff receives frequent, constructive feedback, including interim evaluations as appropriate. Assists staff in obtaining the necessary knowledge, skills and abilities to accomplish goals. EWPs and Evaluations are completed by established deadlines with appropriate documentation. Performance issues are addressed and documented as they occur. Supervision is conducted and documented regularly and complies with any statutory requirements. Encourage a safer work environment and the reduction in employee work-related and non-work-related lost time.35%35%.15%15%100%F. Mission and Values % Time22. Special Assignments23. Measures for Special AssignmentG. ATTACH OFFICIAL ORGANIZATIONAL CHART Physical Demands Worksheet This form is intended to assist supervisors in evaluating the demands of positions. Keep a copy of the completed form with the Employee Work Profile in the employee’s personnel file. Job Title:Employee: If employee performs typical office or administrative work that does not require physical exertion beyond routine sitting, standing, and light lifting, please check here and skip to Part 3, “Emotional Demands”. FORMCHECKBOX PART 1: The physical demands of this position. (without accommodations)Frequency** constant for at least 15 minutesNeverRareOccasionalFrequentSitting. Particularly for sustained periods of time. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Walking. Moving about on foot to accomplish tasks, particularly for long distances or moving from one work site to another. May include uneven surfaces such as gravel, grass, or mounds. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Standing. Particularly for sustained periods of time. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Bending neck up & down and/or twisting sideways. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Running. Typically for short distances to respond to emergency situations. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Stooping. Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full motion of the lower extremities and back muscles. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Balancing. Maintaining body equilibrium to prevent falling and walking, standing or crouching on narrow, slippery, or other uneven surfaces. This factor is important if the amount of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Crouching. Bending the body downward and forward by bending leg and spine. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Climbing. Ascending or descending ladders, stairs, scaffolding, ramps, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Kneeling. Bending legs at knee to come to a rest on knee or knees. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Crawling. Moving about on hands and knees or hands and feet. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Pushing. Using upper extremities to press against something with steady force in order to thrust forward, downward or outward. List Maximum Weight:________ FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Pulling. Using upper extremities to exert force in order to draw, haul or tug objects in a sustained motion. List Maximum Weight: __________ FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Lifting/Carrying. Raising objects from a lower to a higher position or moving objects horizontally from position-to-position. This factor is important if it occurs to a considerable degree and requires substantial use of upper extremities and back muscles. Up to 10 lbs. 11-25 lbs. 26-50 lbs. 51-75 lbs. Over 75 lbs. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Fingering. Picking, pinching, typing or otherwise working, primarily with fingers rather than with the whole hand as in handling. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Grasping. Applying pressure to an object with the fingers and palm. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Repetitive motion. Substantial movements (motions) of the wrists, hands, and/or fingers. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Reaching. Extending hand(s) and arm(s) in any direction. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX PART 2: The environmental demands of this position. NeverRareOccasionalFrequentThe worker is subject to environmental conditions. Protection from weather conditions but not necessarily from temperature changes. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX The worker is subject to outside environmental conditions. No effective protection from the weather. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX The worker is subject to both environmental conditions. Activities occur inside and outside. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX The worker is subject to extreme cold. Temperatures typically below 32° for periods of more than one hour. Consideration should be given to the effect of other environmental conditions, such as wind and humidity. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX The worker is subject to extreme heat. Temperatures above 100° for periods of more than one hour. Consideration should be given to the effect of other environmental conditions, such as wind and humidity. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX The worker is subject to noise. There is sufficient noise to cause the worker to shout in order to be heard above ambient noise level. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX The worker is subject to vibration. Exposure to oscillating movements of the extremities or whole body. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX The worker is subject to hazards. Includes a variety of physical conditions, such as proximity to moving mechanical parts, moving vehicles, electrical current, working on scaffolding and high places, exposure to high heat or exposure to chemicals. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX The worker is subject to atmospheric conditions. One or more of the following conditions that affect the respiratory system or the skin: fumes, odors, dust, mists, gases, or poor ventilation. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX The worker is frequently in close quarters, crawl spaces, shafts, man holes, small enclosed rooms, small sewage and line pipes, and other areas that could cause claustrophobia. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX The worker is required to function in narrow aisles or passageways. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX The worker is required to wear protective equipment such as respirator, mask, earplugs, gloves, goggles, etc. (List specific PPE’s for each hazard under Core Responsibilities) FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX PART 3: The emotional demands of this position. NeverRareOccasionalFrequentThe worker is subject to multiple priorities and stimuli. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Work involves frequent change and/or interruptions. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX The worker is required to have intense customer interaction. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Frequent deadlines must be met. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX The worker must be able to respond to emergency situations appropriately. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX The worker must be able to work overtime as needed. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Other: FORMTEXT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX The Sensory Demands of this position. (with or without corrective devices) FORMCHECKBOX Hearing. Perceiving the nature of sounds at normal speaking levels with or without correction. Ability to receive detailed information through oral communication, and to make the discriminations in sound. FORMCHECKBOX Verbal Communication. Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken information to others accurately, clearly, loudly, and quickly. FORMCHECKBOX Visual acuity including color, depth perception, and field vision. Required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned and to make general observations. FORMCHECKBOX Writing Ability. Able to complete written assignments and write accurate reports and documentation. Additional writing requirements include: FORMTEXT FORMCHECKBOX Reading Ability. Able to read and comprehend instructions, procedures, and policies. Additional reading requirements include: FORMTEXT FORMCHECKBOX Position requires driving/operating a motor vehicle. (If CDL is required, please note in Section II under KSA) I acknowledge and understand that: The Physical Demands Worksheet provides a general summary of the position in which I am employed, that the contents of this worksheet are job requirements and, at this time, I know of no limitations that would prevent me from performing these functions with or without accommodation. I further understand that it is my responsibility to inform my supervisor at any time that I am unable to perform these functions. The EWP and Physical Demands Worksheet are not an exhaustive list of all duties, responsibilities and requirements. Other functions may be assigned and NSU management retains the right to add or change the duties at any time. I am responsible for using the proper procedures, equipment, and personal protection (PPE) while performing the physical demands of my position. I have read and understand this physical demands worksheet. ______________________________________________ ____________________________ Employee Signature Date This page is printed separate from the remainder of the Work Description/Performance Plan because it contains confidential employee information. 24. Annual Requirements: Supervisor ensures annual requirements for position are provided to the employee. Supervisor will evaluate employee annually on compliance with these requirements. Mandatory training courses are completed as instructed. PART III - Employee Development Plan25. Personal Learning Goals (If you complete this section, you must also complete section # 30): 26. Learning Steps/Resource Needs: 27. Confidentiality Statement & Code of ConductI. I acknowledge and understand that I may have access to confidential information regarding employees, students, or the public. In addition, I acknowledge and understand that I may have access to proprietary or other confidential information or business information belonging to NSU and/or the Commonwealth. Therefore, except as required or permitted by law, I agree that I will not: Access or attempt to access data that is unrelated to my job duties at NSU; Use or disclose to any other person, or allow any other person access to, any information related to NSU and/or the Commonwealth that is proprietary or confidential and/or pertains to employees, students, clients, or the public. Use or disclosure of information includes, but is not limited to, verbal discussions, FAX transmissions, electronic mail messages, voice mail communication, written documentation, “loaning” computer access codes, and/or another transmission or sharing of data. II. I understand that NSU and its employees, students, or others may suffer irreparable harm by use or disclosure of proprietary or confidential information and that NSU may seek legal remedies available to it should such use or disclosure occur. ________________________________________________________________________________________________ III. I hereby certify that I have read and agree to abide by the Commonwealth’s Standards of Conduct, Policy #1.60. ________________________________________________________________________________________________ IV. 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Supervisor s Comments: FORMTEXT Supervisor s Signature Print NameEmployee #Date29. Reviewer’s Comments: Reviewer’s Signature Print NameEmployee #Date30. Employee’s Comments: Employee’s Signature Print NameEmployee #DateMy signature acknowledges I have reviewed and discussed with my supervisor the factors upon which my performance will be evaluated and my developmental plan. 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