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<br />Work Environment <br />What duties require you to perform strenuous activity? (Give examples and state how often <br />and how long you perform those duties.) <br /> <br />What safety hazards do you face when you perform your job? <br /> <br />Additional Comments: <br />List any other factors you feel would be helpful for this evaluation. \i our position will be <br />reevaluated only for placement within the established pay plan. Salary information from <br />other cities will not be included as part of this reevaluation.) <br /> <br />I attest that the statements made above are true and that I have completed this form to the <br />best of my ability. <br /> <br />Employee Signature <br /> <br />Date <br />