Internship Site Summary
Larimer County Economic and Workforce Development Department
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Federal Employer ID Number (FEIN)
Street Address Line 2
Will this position be remote or hybrid?
Primary Supervisor's Name
Primary Supervisor's Title / Department
Primary Supervisor's Phone Number
Primary Supervisor's E-Mail
Back-up Supervisor's Name
Back-up Supervisor's Title / Department
Back-up Supervisor's Phone Number
Back-up Supervisor's E-mail
Company Website Address
Enter URL or N/A if not applicable
How many employees does your business have?
Internship Position Information
Internship Position Title
Give a general description of the tasks involved in this position (if possible, attach a job description with this site summary).
Are any specific skills, training, or experience required prior to placement in internship?
What skills, training or experience are required, please explain:
What skills will the candidate gain during this internship?
Additional comments specific to your worksite (ie. age, bilingual skills, dress code, specific clothing / equipment required).
Select the option(s) that best describes your working environment.
Teamwork concept (lots of interactions with co-workers)
Very busy (hectic - must meet deadlines)
Busy (steady workload)
Independant (work at your own pace, minimal contact with people)
Intense (high volume traffic)
Very quiet office
Approximately how many hours per week are needed to complete tasks?
Please state the preferred work days and hours for this internship.
How many interns can you host in this role?
If yes please explain
Does the business require any of the following for ALL employees?
Criminal background check
No pre-employment requirements
Would you consider an applicant with a criminal background?
Possibly, depending on the charges
Yes, with the following exceptions
Please list exceptions:
How much noise is typical for the work environment for this internship?
Very quiet (forest trail, isolation booth for hearing test)
Quiet (library, private office)
Moderate noise (business office with typewriters and printers, working outdoors)
Loud noise (manufacturing, large earth moving equipment, mowers, weed eaters)
Very loud noise (jackhammer work, front row at a rock concert)
Is protective equipment used?
If yes, what protective equipment is used?
Is safety training provided?
If yes, what safety training is provided?
Check the extent of physical capacity requirements listed below:
Occasionally (up to 2 hrs per day)
Frequently (2-5 hrs per day)
Continuously (5 or more hours with scheduled breaks)
Lift up to 10 lbs
Lift up to 20 lbs
Lift up to 50 lbs
Lift over 50 lbs and up to 100 lbs
Squat, crawl, kneel
Reach above shoulders
Grasp, right hand
Grasp, left hand
Climb ladders and other surfaces
Perform fine finger manipulations
Machinery with moving parts
Dust, fumes, gases, and airborne particles
Marked temperature or humidity changes
Other bright light
Wet, humid conditions (non-weather)
Risk of electrical shock
Toxic or caustic chemicals
Outdoor weather conditions
Work in high, precarious positions
Extreme cold (non-weather)
Extreme heat (non-weather)
Work with explosives
Risk of radiation
If lifting 50 lbs. or more is frequently, occasionally, or continuously required, is lift assist equipment or a coworker partner provided?
Will driving any non-motorized vehicles be required in this internship? (i.e., tow motor, golf cart, lawn mower, etc.)
Will driving any motorized vehicles be required for this internship?
Interns may not operate a motor vehicle during work hours. This includes the intern’s personal vehicle. Please explain your situation:
Workforce Center Contact
For Larimer County Risk Assessment use only
Job Analysis Classification
Not Yet Approved
Risk Approval Signature
Job Order #:
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