Dishwasher Utility Worker Page 5

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NA
NE
O
F
C
Communicating by writing/reading
Distinguishing odors by smell
Distinguishing tastes
Exposure to wild/dangerous animals
Exposure to insect bites or stings
Work/travel in boat/small aircraft
Exposure to aggressive/angry people
Restraining/grappling with people
Other:
Other:
Items checked above must be consistent with tasks listed.
Are there any other physical or mental requirements of this position
not addressed above?
I have read and understand the physical requirements and potential hazards of this
position and am able to perform the physical requirements as stated above with or
without reasonable accommodation.
Employee Signature
Date
FWPDA Dishwasher
Revised 3-8-2016

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