Selective placement for the handicapped : information for the placement of disabled applicants in competitive employment / War Manpower Commission, United States Employment Service.

Date:
1945
Catalogue details

Licence: Public Domain Mark

Credit: Selective placement for the handicapped : information for the placement of disabled applicants in competitive employment / War Manpower Commission, United States Employment Service. Source: Wellcome Collection.

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    Form USES-546 (1-45) PHYSICAL CAPACITIES REPORT NAME OF APPLICANT —__________ ADDRESS NATURE OF DISABILITY PROGNOSIS (Date of last examination) PLEASE INDICATE THIS APPLICANT'S PHYSICAL CAPACITY AS FOLLOWS: LEAVE BLANK ANY ITEM FOR WHICH HIS CAPACITY IS NORMAL. CHECK THE NO COLUMN FOR EACH ACTIVITY THAT IS FORBIDDEN. CHECK THE LIMITED COLUMN FOR ITEMS FOR WHICH HIS CAPACITY IS LIMITED: IF LIMITATION IS ASCERTAINABLE, DESCRIBE ON-REVERSE OF THIS FORM. Peas wis | LIMITED WORKING CONDITIONS UTSIDE A et? aa =j|o aliciz|o m|2 4)~< ie {GH TEMPERATURE OW TEMPERATURE UDDEN TEMP. CHANGES DUSTY DIRTY ODORS NOISY ADEQUATE LIGHTING ADEQUATE VENTILATION VIBRATIONS MECHANICAL HAZARDS MOVING OBJ ECTS CRAMPED QUARTERS . Rs HIGH PLACES EXPOSURE TO BURNS ELECTRICAL HAZARDS EXPLOSIVES © RADIANT ENERGY TOXIE CONDITIONS WORKING WITH OTHERS WORKING AROUND OTHERS WORKING ALONE COLOR VISION DEPTH PERCEPTION WORKING SPEED 1. IF CARDIAC DISABILITY, PLEASE GIVE AMERICAN HEART ASSOCIATION CLASSIFICATION , OTHERWISE STATE RECOMMENDATIONS UNDER “REMARKS.” 9. IF TBc, SPECIFY: APPARENTLY CURED [] ARRESTED [| APPARENTLY ARRESTED [_] QUIESCENT [_ ] : SPUTUM: + [_] —[_] AS OF MAY WORK HRS/DAY DAYS/WK. vee 3. IF_NEURO-PSYCHIATRIC, INCLUDE ANY APPLICANT AND. WORK LIMITATIONS INFORMATION ON ASSETS OF 4. ALLERGENS TO AVOID