Fill and Sign the Exempt Survey Form

EXEMPT SURVEY In order to classify any individual as exempt from overtime, the employee is to complete the following survey. The supervisor is then to provide the survey to the Human Resources Department so it may properly classify the employee as exempt or nonexempt. A copy of the survey is to be retained in the employee’s personnel file. Name: ___________________________________ Department: _____________ Job Title: _________________________________ Date: ___________ 1. How many employees do you supervise? _______ List job titles of employees you supervise: ___________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 2. Check each activity in which you engage: Manage a department or facility Interview applicants Recommend which applicants to hire Review employees’ performance Recommend pay increases for employees Recommend promotions Handle complaints from employees Handle complaints from customers Discipline employees Recommend discipline for employees Assign work to employees Order equipment, supplies, or other items Responsible for safety of employees and property Regularly and customarily exercise discretion and independent judgment in making significant business decisions Apply policies Regularly and directly assist an executive or administrator Work only under general supervision Provide professional services Train others Supervise two or more full-time employees or their equivalent Perform work directly related to company policies or general business operations Perform administrative functions Customarily and regularly exercise creative talent Computer systems analysis Computer programming Software functions 3. Using the checklist as a guide, state the primary duties of your position. Feel free to add duties not on the list. __________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 4. Describe the types of decisions you have the authority to make: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 5. List any special projects that you handle in your position: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 6. How much supervision do you receive (check one)? Nominal Direction – Subject only to very broad communications from a supervisor; always exercise independent discretion and judgment in significant matters. General Direction – Receive very general guidance with respect to overall objectives; usually exercise independent discretion and judgment regarding significant matters; operate within company guidelines using independent discretion or judgment to achieve assigned objectives. Direction – Receive guidance with respect to general objectives; operate within specific policy guidelines; occasionally use independent discretion and judgment. General Supervision – Work is reviewed upon completion; routine duties are performed with minimum supervision; proceed alone at routine work using standard practices and procedures; occasional check of work while in progress. Immediate Supervision – Receive close supervision related to specific work activities, assignments, and methods; receive detailed instructions; exercise very little discretion or independent judgment. 7. Please describe your planning and scheduling activities and responsibilities. For example, is your primary job to plan/schedule activities for yourself and/or others or are all your activities planned by others? _________________________________________ _______________________________________________________________________ _______________________________________________________________________ 8. List below examples of decisions you are required to make on a regular and recurring basis. __________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 9. For each decision listed, indicate whether the decision is reviewed before being implemented. If it is reviewed, describe the type of review using the definitions in item 6. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 10. For what physical or financial sources are you responsible, e.g. preparing budgets, ordering equipment or material, petty cash, and the like? __________________________ _______________________________________________________________________ _______________________________________________________________________ 11. What knowledge skills and abilities does a person need to perform your job? _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 12. What academic degrees do you hold? _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 13. Describe your regular/normal work hours: __________________________________ 14. What is your weekly salary? _____________________________________________