Charlotte-mecklenburg Risk Management Checklist

Workstation photos

Employee Information

Employee Name:

Job Title:

Department:

Phone number:

Supervisor's Name:

Gender:

Male
Female

Height (inches):

4'8"
4'9"
4'10"
4'11"
5'0"
5'1"
5'2"
5'3"
5'4"
5'5"
5'6"
5'7"
5'8"
5'9"
5'10"
5'11"
6'0"
6'1"
6'2"
6'3"
6'4"
6'5"
6'6"
6'7"
6'8"

Dominate Hand:

Corrective Lenses:

None
Reading Glasses
Glasses
Bifocals
Trifocals
Contact Lenses
Other

Average hours spent in the office?

4
5
6
7
8
9
10
11
12

What is the longest period of time that work is performed without getting up for 30 seconds?

30 minutes
1 hour
1.5 hours
2 hours
2.5
3 hours
4 hours

Does the employee perform stretching exercises?

Yes
No
Informal, only when they feel tightness
Physician prescribed regimen
Physical Therapist prescribed regimen
Exercise in the evening with regular stretching

Employee Comments:

Task Breakdown (% of employee's work)

Field work (%):

Concurrent with other tasks
Variable
0
5
10
15
20
25
30
35
40
50
55
60
65
70
75
80
85
90
95
100

Face to face client interaction (%):

Concurrent with other tasks
Variable
0
5
10
15
20
25
30
35
40
50
55
60
65
70
75
80
85
90
95
100

Phone usage (%):

Concurrent with other tasks
Variable
0
5
10
15
20
25
30
35
40
50
55
60
65
70
75
80
85
90
95
100

Keyboard (%):

Concurrent with other tasks
Variable
0
5
10
15
20
25
30
35
40
50
55
60
65
70
75
80
85
90
95
100

Mouse (%):

Concurrent with other tasks
Variable
0
5
10
15
20
25
30
35
40
50
55
60
65
70
75
80
85
90
95
100

Writing/Drawing/Filing (%):

Concurrent with other tasks
Variable
0
5
10
15
20
25
30
35
40
50
55
60
65
70
75
80
85
90
95
100

Time Away from Workstation (%):

Concurrent with other tasks
Variable
0
5
10
15
20
25
30
35
40
50
55
60
65
70
75
80
85
90
95
100

Other (%):

Concurrent with other tasks
Variable
0
5
10
15
20
25
30
35
40
50
55
60
65
70
75
80
85
90
95
100

Concurrent work description that causes % to be > 100:

Chair

Can the chair height be adjusted so the worker's thighs are parallel to the floor?

Can the lumbar support be adjusted so that it fits into the worker's lumbar region on their back?

Does the backrest recline have a lockout to support the worker in an upright posture?

Can the armrests be adjusted to just below the elbow of the worker?

Can the seat pan depth be adjusted to allow three fingers width between the back of the worker's knee and the front of the seat pan?

Do the armrests allow the worker to get close enough to the workstation?

Actions taken:

Adjusted height of the chair
Adjusted lumbar support
Adjusted arm rests
Adjusted seat pan depth
Reevaluate chair during follow up assessment
Recommend an alternate chair

Comments on Chair:

Keyboard Tray, Keyboard & Pointing Device

If the chair needs to be raised to position the worker better with respect to the keyboard and pointing device, is there a foot rest available to keep the worker's thighs parallel to the floor?

Is there an articulating keyboard tray installed at the workstation?

Is the keyboard tray stable?

Is the keyboard tray large enough for both the keyboard and the pointing device?

Does the keyboard tray need to be replaced?

Does the angle of the keyboard allow the wrists to be straight?

Is the employee having symptoms in the hands/wrists/elbows?

Recommend providing a vertical mouse
Recommend providing an ergonomic keyboard

Does the mouse fit the hand?

Is the pointing device located next to the keyboard?

Is a wrist rest, or padding, available to protect against hand or forearm contact with sharp or hard edges?

Add wrist rest for:

Keyboard
Pointing Device

Is the employee required to lean against the wrist rest to perform tasks?

If a laptop computer is used, are an external keyboard and pointing device provided?

Actions taken:

Adjusted keyboard tray
Adjusted location of mouse
Adjusted location of keyboard
If keyboard/mouse on desk top, trained to slide all the way under the desk
Recommend providing a vertical mouse
Recommend providing an ergonomic keyboard
Recommend installing an adjustable keyboard tray

Comments on Keyboard Tray, Keyboard, and Pointing Device:

Monitor & Source Document

If a laptop computer is used, is an external monitor provided?

Is the monitor located in front of the employee?

Is the monitor approximately an arm's length away from the worker?

Is the monitor set at a height so that the top row of the characters on the screen is even with the seated eye height of the user?

Is the font size, screen contrast and/or image quality in print and on the monitor acceptable?

If a document holder is used, is the document holder located adjacent to the monitor?

Actions taken:

Moved monitor(s) in front of employee
Repositioned the monitor(s) an arm's length away from the employee
Raised height of the monitor(s)
Lowered height of the monitor(s)
Adjusted location of the document holder
Adjusted the resolution of the monitor
Recommend providing an adjustable document holder
Recommend adjusting location/height of monitor(s) once equipment is provided

Comments on Monitor & Source Document:

Phone & Printer

Is the phone located on the same side as the hand that is used to answer it?

Handset/Headset:

Can the phone be answered without extended reaching?

Does the employee talk on the phone without cradling it on their shoulder?

Does the employee utilize speaker phone or a headset while participating in conference calls?

Does the employee have a printer?

Can the printer be accessed without extended reaching?

Actions taken:

Moved the phone to the same side as the hand that is used to answer it
Moved phone closer to the employee
Moved the location of the printer to within an arm's reach of the employee

Comments on phone and/or pinter:

Work Surface

Is there sufficient space for all equipment and accessories?

Are frequently used equipment and supplies within an arm's reach?

Is the work surface height adjustable?

Actions taken:

Reorganized equipment
Reorganized furniture
Adjusted work surface height
Reevaluate the work surface height during the follow up assessment

Comments on Work Surface:

Workspace

Is the CPU in a location that does not interfere with positioning of the the employee at the workstation?

Can the employee move about the workspace easily, free from equipment or supplies obstructing movement?

Is there adequate leg clearance (height, width, depth)?

Is there sufficient storage and filing room to keep the work area free from clutter?

Actions taken:

Repositioned CPU
Reorganized work space

Comments on Work Space

Environment

Is lighting adequate for all tasks?

Is the monitor screen free of glare from overhead lighting?

Are monitors free from glare from windows?

Is the workstation climate acceptable?

Actions taken:

Reduced overhead lighting
Changed location of monitor(s)
Adjusted blinds, curtains, etc.
Adjusted the work station climate

Comments on Environment

Evaluator Actions

Provided reference material for employee to properly adjust their workstation (chair, keyboard, mouse, monitor, etc.).
Provided training on proper neutral ergonomic postures.
Recommended the employee request a follow-up assessment once recommendations are met.

Summary of Recommendations

Recommendations:

Provide an alternate chair with adjustable height, arm rests (height & width), lumbar support, & seat pan depth.
Change chair cylinder to a "low height" cylinder.
Adjust chair once keyboard tray is installed.
Install an adjustable keyboard tray (wide enough for a mouse as well).
Provide an adjustable foot rest.
Provide a vertical mouse
Provide an ergonomic style keyboard.
Repair keyboard tray
Add wrist rest for keyboard (if not on keyboard tray).
Add wrist rest for mouse (if not on keyboard tray).
Provide an external monitor.
Provide an external mouse.
Provide an external keyboard.
Move monitor(s) directly in front of employee.
Move monitor(s) to within an arm's length of the employee.
Raise height of monitor(s).
Lower height of monitor(s).
Adjust the location/height of monitor(s) once equipment is provided
Provide an adjustable document holder.
Change resolution/size of text of the monitor.
Move phone to dominate hand side within an arm's length.
Provide a telephone headset.
Adjust height of the work surface.
Provide a sit/stand workstation that promotes a healthy balance of sitting/standing/walking. 70% sitting, 25% standing, and 5% walking
Provide an anti-fatigue mat
Reevaluate the chair during the follow up assessment.
Reevaluate the pointing device during the follow up assessment.
Reevaluate the keyboard during the follow up assessment.
Reevaluate the work surface height during the follow up assessment.
Reevaluate the need for a keyboard tray during the follow up assessment.
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