CUPE Questionnaire - March 2011 Revision
CUPE Questionnaire - March 2011 Revision
CUPE Questionnaire - March 2011 Revision
Questionnaire
INTRODUCTION
The purpose of this questionnaire is to help you describe your job and tell us the
conditions under which you carry it out so we may analyze it. Please read this
questionnaire carefully and print your response legibly in pen. Provide as much
detail as possible and attach additional pages, if necessary. You may find that some
questions do not relate to your job. If this is the case, please write N/A (not applicable) in
the space provided.
All answers will be treated confidentially and will be used solely to develop job
descriptions and carry out an evaluation of the job. This questionnaire is not about your
job performance, and your job performance will have no impact on the evaluation of the
position. Employees doing the same job are encouraged to discuss their duties with
each other. Group submissions are preferred if each person is in agreement with the
response and signs the back page.
It is important that supervisors read the employees= submissions and are encouraged to
make comments. Supervisors are asked not to change an employee=s response but to
comment in the space provided for each question.
For further information, please contact one of the following Steering Committee
members:
Feel free to keep a copy of the questionnaire once you and your supervisor have
completed and signed it.
Contact Angie McLaughlin, Human Resources, (ext. 56703), should you have any
questions.
Revised January 2007
Job Analysis Questionnaire
PLEASE PRINT
Date Completed:
Title of Job:
Department/Division:
Location of Work:
Employee Status: (X) Regular full time: Probationary: Temporary full time:
QUESTION NO 1 - KNOWLEDGE
A) In the corresponding column check the education level you consider is required to
do your job.
EDUCATION LEVEL
Grade 10 or less
Grade 12
University B Specify:
Please specify:
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Comments:
Supervisor=s Initials:
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How many months and/or years of experience (acquired either on the job or elsewhere)
are needed to acquire the skills necessary to do your job satisfactorily? (i.e., the time
required to learn internal and external procedures, resources, as well as specialized
skills).
Up to one month
Over 1 up to 3 months
Over 3 up to 6 months
Over 6 months up to 1 year
Over 1 up to 2 years
ove
Over 2 up to 3 years
Over 3 up to 4 years
Over 4 up to 5 years
Over 5 years B specify:
Please give examples of the job duties you were considering in making your
determination(s):
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Supervisor=s Initials:
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A) Describe some typical problems that you generally solve on your own, using your
experience and expertise.
B) Describe some typical problems that you would usually pass on to your supervisor or
a colleague.
C) Describe some typical problems that you would solve by referring to manuals, policy
books or industry codes.
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D) What guidelines, procedures and/or manuals assist you in carrying out your job
duties?
E) Does your job require you to develop new work methods, procedures or manuals?
Comments:
Supervisor=s Initials:
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A) Please describe those duties of your job which require periods of mental, aural
(listening and visual concentration such as operating a switchboard, reading, driving,
inputting data, or a combination of the five senses, sight, taste, smell, touch and
hearing are required in the course of doing the job that result in mental/sensory
fatigue.
Duration Frequency
Approx. Once in a Several Most working
Give examples of mental effort:
hrs/day while times daily hours
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Please explain:
Comments:
Supervisor=s Initials:
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A) Not taking into account exceptional circumstances, does your job require:
Other: Specify:
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B) During the course of a working day or shift, what period of time is you required to:
Please explain:
Comments:
Supervisor=s Initials:
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QUESTION NO 6 - DEXTERITY
A) Does your work require accurate hand/eye or hand/foot coordination? This can be a fine
movement such as keyboard kills, arc welding, giving injections, drafting, repairing fine
instruments/equipment, dispensing oral medications
OR
coarse movement such as using long/handled tools such as mops and shovels, floor
polishers, lawn mowers, stocking shelves, folding laundry, sorting mail.
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C) Please indicate the type of tools, equipment, machines, etc., you are required to use
or operate in carrying out your job duties.
D) Are you required to clean, maintain, adjust, service or repair any of the tools,
equipment or machines you have listed above?
Comments:
Supervisor=s Initials:
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QUESTION NO 7 - ACCOUNTABILITY
It is recognized that innocent errors can happen when carrying out job duties, such errors
are not classed as careless mistakes and are not punishable.
A) 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 you job and indicate
the consequences such as delays, financial loss, effect on others, disruption or delay of
service.
Explain:
An activity involving others could be delayed or an error would result in minor loss of
resource.
Explain:
Explain:
Explain:
Explain:
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B) What would be the effect of errors on others in terms of the loss of time, the effect on
the work or the impact on the public image of the most serious errors that could be
committed in the carrying out of your job duties?
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Comments:
Supervisor=s Initials:
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The workplace, machines, tools and equipment must be safe and employees must observe
safety rules.
A) Do you work:
Alone
As part of a work team or group (with other employees, whether or not they belong to
your organization).
B) What potential physical injury or harm could you cause to co-workers and/or others?
Please explain by describing the nature and seriousness of the injury that may occur.
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Comments:
Supervisor=s Initials:
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B) Which statement best describes your responsibility for supervision of the work of others?
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Comments:
Supervisor=s Initials:
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From the list below, identify the usual contacts you are required to make in your job.
Communication skills include oral presentations, writing, listening and/or observation skills.
Choose the words that best describe the nature or purpose of your contact from the
following list of words:
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Comments:
Supervisor=s Initials:
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A) Is there some degree of unpleasantness in the day-to-day activities of your job? For
each condition which is applicable, give an example or indicate not applicable (N/A).
Check one frequency level.
Little Once in a while
Occasional Once in a while, most days
Frequent Several times a day on a daily basis, or at least four days per week
Almost continuous Almost all working hours for at least an average of four days per week
Almost
Element Example or N/A Little Occasional Frequent
continuous
Chemical/cleaning substances
Dust/Dirt
Extreme temperatures
Grease/Oil
Inadequate ventilation
Inadequate lighting
Inclement weather
Infectious disease
Interruptions
Lack of privacy
Moisture/Steam
Noise
Odor
Smoke/Fumes
Travel
Vibration
X-rays
Other- Specify:
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Do you work:
Year round Spring Summer Fall Winter
C) What precautions or safety measures do you need to take to avoid a work injury to
yourself?
Explain:
Explain:
Physical abuse
Explain:
Threats
Explain:
Clients, patients, students, taxpayers, general public, etc. who are difficult to deal with
Explain:
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Comments:
Supervisor=s Initials:
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1. List the duties you regularly perform EACH DAY, indicating for each the number of
hours.
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2. List the duties you regularly perform EACH WEEK, indicating for each the number of
hours.
3. List the duties you regularly perform EACH MONTH, indicating for each the number of
hours.
4. List the duties you regularly perform ONCE A YEAR or OCCASIONALLY indicating for
each the number of hours.
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5. JOB SUMMARY
In a few words, provide a general description of your job. In other words, what do
you do?
EMPLOYEE=S SUMMARY
(Please add any additional information or comments)
_______________________________________ ______________________
Signature Date
If this questionnaire is being submitted on behalf of a group of employees doing the same job, then each
employee must sign to indicate that he or she agrees with the responses.
_______________________________________ ______________________
Signature Date
_______________________________________ _______________________
Signature Date
_______________________________________ _______________________
Signature Date
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In the box above AYour Job@ fill in the title of your immediate supervisor. This will be the
position to which you directly report.
In the box below AYour Job@ fill in the title of positions which directly report to you.
Be sure to write in the title of the position, not the name of the person currently in the job.
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Your Job
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Titles of positions which report to you
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SUPERVISOR=S SUMMARY
(Please add any additional information or comments)
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