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Ange for each activity based on 8-hr. day Sit 0 1 2 3 4 5 6 7 8 Stand 0 1 2 3 4 5 6 7 8 Walk 0 1 2 3 4 5 6 7 8 Section 2: Based on 8-hr. day, the patient can: (check appropriate columns) Never Occasionally Frequently Continuously 0% 1% - 33% 34% - 66% 67% - 100% Lift - pounds 0-10 11-20 21-25 26-50 51-100 Carry - pounds 0-10 11-20.

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