INSTRUCTIONS FOR USE OF FUNCTIONAL ABILITY
HEALTH QUESTIONNAIRE (SPB 2066)
This questionnaire may be subject to change based upon feedback received
from departments and employee organizations. There is currently no Board
regulation or decision that requires departments to use this specific
questionnaire. It is intended as an alternative to the STD 910 - “Essential
Functions Health Questionnaire” available in January 2002.
This questionnaire is designed to be used in conjunction with offers of
employment extended to individuals for those jobs that do not require a physical
examination. Departments should continue to use Form STD 610 (11/86) for
those positions that require a physical examination prior to placement.
The department Personnel Office must supply a current duty statement for the
actual position being offered. The duty statement must reflect the actual duties
performed by the position being offered, and must designate which of those
functions are “essential.”
For each applicable category listed in Section II of the Questionnaire, the
Personnel Office must specifically identify those essential functions of the
position that are implicated by the question.
Completed Questionnaires may be forwarded to the State Medical Officer at 801
Capitol Mall, Sacramento, CA 95814 for review as part of the consultation
process as questions arise. Stephen Weyers, M.D. may be reached at
(916) 653-0790, CALNET 453-0790 or TDD (916) 653-1498.
ESSENTIAL FUNCTIONS TEST
The term essential functions means the fundamental job duties of the
employment position the individual with a disability desires. The term “essential
functions'' does not include the marginal functions of the position. The essential
functions are those functions that the individual who holds the position must be
able to perform unaided or with the assistance of a reasonable accommodation.
The inquiry into whether a particular function is essential initially focuses on
whether the employer actually re