Hiland Dairy Foods Company ESSENTIAL JOB FUNCTIONS ASSESSMENT PHYSICIAN 'S REPORT NAME OF CANDIDATE: AVAILABLE JOB: Dairy Plant Worker FULL TIME TO BE COMPLETED BY COMPANY ESSENTIAL JOB FREQUENCY OF DURATION FUNCTIONS REPETITION Hours 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'NAME OF CANDIDATE' and 'AVAILABLE JOB' fields at the top of the form. Ensure accuracy as this information is crucial for identification.
3. In the 'ESSENTIAL JOB FUNCTIONS' section, fill out the frequency and duration of each physical task listed. Use the provided hours and percentages to indicate how often these tasks are performed during a shift.
4. For lifting and carrying tasks, specify the weight ranges and corresponding hours. This will help assess physical demands accurately.
5. Complete the 'MEDICAL SUITABILITY FOR JOB' section by selecting 'Yes' or 'No'. If restrictions apply, provide explanations in the designated area.
6. Finally, ensure that a physician signs and dates the report at the bottom before submission.

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