Comprehensive Office Ergonomic Assessment

• Employee Name:

• Prepared by: LGIS Injury Prevention Consultant

• Location
  Address

• LGA:

• Department:

• Job Role:

• Conducted on

  Date

Musculoskeletal Discomfort

• In the past week have you experienced any aches, pains or discomforts in your MS system?

  Yes

  No

• Body Location

  Select Neck Neck and Shoulders Upper Back Lower Back Wrist Forearm Fingers Thumb Shoulder Left Right Centre Across the band Both Wrist Elbow Hip/s Knee Ankle Top Bottom Front/Anterior Back/Posterior Mid Back

  • Neck
  • Neck and Shoulders
  • Upper Back
  • Lower Back
  • Wrist
  • Forearm
  • Fingers
  • Thumb
  • Shoulder
  • Left
  • Right
  • Centre
  • Across the band
  • Both
  • Wrist
  • Elbow
  • Hip/s
  • Knee
  • Ankle
  • Top
  • Bottom
  • Front/Anterior
  • Back/Posterior
  • Mid Back

• VAS MAX

• VAS AVERAGE

• Level of Interference

  Select Nil Mild Significant

  • Nil
  • Mild
  • Significant

• Body Location

  Select Neck Neck and Shoulders Upper Back Lower Back Wrist Forearm Fingers Thumb Shoulder Left Right Centre Across the band Both Wrist Elbow Hip/s Knee Ankle Top Bottom Front/Anterior Back/Posterior Mid Back

  • Neck
  • Neck and Shoulders
  • Upper Back
  • Lower Back
  • Wrist
  • Forearm
  • Fingers
  • Thumb
  • Shoulder
  • Left
  • Right
  • Centre
  • Across the band
  • Both
  • Wrist
  • Elbow
  • Hip/s
  • Knee
  • Ankle
  • Top
  • Bottom
  • Front/Anterior
  • Back/Posterior
  • Mid Back

• VAS MAX

• VAS AVERAGE

• Level of Interference

  Select Nil Mild Significant

  • Nil
  • Mild
  • Significant

• Body Location

  Select Neck Neck and Shoulders Upper Back Lower Back Wrist Forearm Fingers Thumb Shoulder Left Right Centre Across the band Both Wrist Elbow Hip/s Knee Ankle Top Bottom Front/Anterior Back/Posterior Mid Back

  • Neck
  • Neck and Shoulders
  • Upper Back
  • Lower Back
  • Wrist
  • Forearm
  • Fingers
  • Thumb
  • Shoulder
  • Left
  • Right
  • Centre
  • Across the band
  • Both
  • Wrist
  • Elbow
  • Hip/s
  • Knee
  • Ankle
  • Top
  • Bottom
  • Front/Anterior
  • Back/Posterior
  • Mid Back

• VAS MAX

• VAS AVERAGE

• Level of Interference

  Select Nil Mild Significant

  • Nil
  • Mild
  • Significant

• Body Location

  Select Neck Neck and Shoulders Upper Back Lower Back Wrist Forearm Fingers Thumb Shoulder Left Right Centre Across the band Both Wrist Elbow Hip/s Knee Ankle Top Bottom Front/Anterior Back/Posterior Mid Back

  • Neck
  • Neck and Shoulders
  • Upper Back
  • Lower Back
  • Wrist
  • Forearm
  • Fingers
  • Thumb
  • Shoulder
  • Left
  • Right
  • Centre
  • Across the band
  • Both
  • Wrist
  • Elbow
  • Hip/s
  • Knee
  • Ankle
  • Top
  • Bottom
  • Front/Anterior
  • Back/Posterior
  • Mid Back

• VAS MAX

• VAS AVERAGE

• Level of Interference

  Select Nil Mild Significant

  • Nil
  • Mild
  • Significant

Workstation dissatisfaction

• Is there anything within your workstation that you feel is incorrect, malfunctioning or uncomfortable?

  Yes

  No

• Select item/s of issue

  Select Chair Desk Monitor/s Keyboard Mouse Telephone Workstation layout Paperwork area Storage

  • Chair
  • Desk
  • Monitor/s
  • Keyboard
  • Mouse
  • Telephone
  • Workstation layout
  • Paperwork area
  • Storage

• Other, please detail:

• LHS Pre-Assessment Photo

  Media

• Centre Pre-Assessment Photo

  Media

• RHS Pre-Assessment Photo

  Media

Ergonomic Chair

• What features does the current chair provide:

Ergonomic chair features

• Features

  Select Seat pan slider Lumbar height adjustment Lumbar tension adjustment Seat back angle Seat pan tilt Synchro mechanism Synchro tension Fixed armrests Adjustable armrests Seat height

  • Seat pan slider
  • Lumbar height adjustment
  • Lumbar tension adjustment
  • Seat back angle
  • Seat pan tilt
  • Synchro mechanism
  • Synchro tension
  • Fixed armrests
  • Adjustable armrests
  • Seat height

• Other features:

• Has the employee completed any adjustments?

  Yes

  No

• Does the employee understand the chairs functions?

  Safe

  At Risk

  N/A

• Is there a 2 - 4 finger space at the back of the knee?

  Yes

  No

• Seat pan adjusted

• New chair required

• Does the chair fit the user?

  Safe

  At Risk

  N/A

• New chair required

• Is there adequate lumbar support?

  Yes

  No

• Is the lumbar support positioned correctly?

  Yes

  No

• Lumbar supported adjusted

• Is the backrest adjusted to employee comfort?

  Yes

  No

• Backrest angle adjusted

• Is the seat tilt adjusted to employee comfort?

  Yes

  No

• Seat pan tilt adjusted

• Does the backrest provide adequate upper back support?

  Yes

  No

• New chair required

• Does the chair have armrests which prevent access to the workstation?

  Yes

  No

• Armrests removed

• Does the seat cushion still provide support?

  Safe

  At Risk

  N/A

• New chair required

• Does the chair have any malfunctions?

  Safe

  At Risk

  N/A

• New chair required

Desk

• Is the desk height adjustable, or a sit to stand workstation?

  Yes

  N/A

• Is there sufficient space at Designated Working Position (700mm deep x 650mm - 550mm wide x 720mm -750mm high)?

  Safe

  At Risk

  N/A

• Is under the desk free of clutter?

  Safe

  At Risk

  N/A

• Is the desk compliant with:

  Safe

  At Risk

  N/A

• Data Entry (600mm deep x 1200mm wide)

• Clerical Work (600mm deep x 1800mm wide)

• Is the employee sitting with elbow at 90-100 degrees when using the keyboard?

  Yes

  No

• Chair height adjusted

• Desk height adjusted

• Is the employee able to place their entire foot flat on the ground?

  Yes

  No

• Footrest required

• Desk height adjusted

• Does the employee rest their elbows, wrists or forearms for long periods and experience discomfort?

  Yes

  No

• Gel mouse pad required

• Gel keyboard pad required

• Is the layout / orientation of the desk suitable for the employee?

  Yes

  No

• Desk layout modified

• Please detail recommended ergonomic equipment:

• Please list any other additional equipment / requirements

• Please select a Sit-stand workstation option from those below: This is general guidance, please seek with supplier in regards to your organisation

Monitor

• Is the employee seated directly behind monitors?

  Yes

  No

• Monitor position adjusted

• Is the monitor/s height adjusted to the employee?

  Yes

  No

• Monitor height adjusted

• Is the monitor/s distance adjusted to the employee?

  Yes

  No

• Monitor distance adjusted

• Is the monitor/s angle adjusted to the employee?

  Yes

  No

• Monitor angle adjusted

• Does the employee have multiple monitors?

  Yes

  No

  N/A

• Does the positioning of the monitor reflect usage?

  Safe

  At Risk

  N/A

• 90/10

• 80/20

• 70/30

• 60/40

• 50/50

• Are the monitors adjusted to the same height, distance and angle?

  Safe

  At Risk

  N/A

• Monitors matched

• Do the monitors have the same brightness and contrast levels?

  Safe

  At Risk

  N/A

• Brightness matched

• Contrast matched

• Is the employee impacted by any glare or reflection issues?

  Yes

  No

• Is the display size (font setting) suitable for the employee?

  Yes

  No

• Display size increased (medium)

• Display size increased (large)

• Please detail any required ergonomic equipment

• If other equipment, please detail:

Keyboard

• Is the keyboard directly in front of the employee?

  Yes

  No

• Keyboard relocated

• Is the keyboard (spacebar) positioned within 10cm of desk edge?

  Yes

  No

• Keyboard relocated

• Does the employee utilise shortcut keys?

  Yes

  N/A

• Education provided

• Is the keyboard angle raised and wrist discomfort experienced?

  Yes

  No

• Keyboard angle flattened

• Please detail any required ergonomic equipment

• If other equipment, please detail:

• Is the mouse positioned on the same level and next to the keyboard?

  Yes

  No

• Mouse relocated

• Which hand does the employee use for the mouse?

  Left

  Right

• Has the employee experienced any aches, pains or discomfort in the wrist, forearm or elbow?

  Yes

  No

• Has the employee switched to use their non-dominant hand?

  Yes

  No

  N/A

• Non-dominant hand usage

• Is the mouse a suitable size for the employees' hand?

  Yes

  No

  N/A

• Please detail any required ergonomic equipment

• If other equipment, please detail:

Telephone

• Is the landline telephone placed on the employees' non-writing side?

  Yes

  No

• Relocated (non-writing)

• Is the landline telephone within easy reach of the employee?

  Yes

  No

• Relocated (within reach)

• What percentage of the workday is the employee on the landline telephone?

• Headset required

• Is the mobile telephone placed on the employees' non-writing side?

  Yes

  No

  N/A

• Relocated (non-writing)

• Is the mobile telephone within easy reach of the employee?

  Yes

  No

  N/A

• Relocated (within reach)

• What percentage of the workday is the employee on the mobile telephone?

• Is there a need to complete computer tasks when on phone calls?

  Yes

  No

  N/A

• Headset required

• Is the headset lightweight, wireless, adjustable and comfortable?

  Yes

  No

  N/A

• Would the employee prefer a headset for telephone operations?

  Yes

  No

  N/A

• Which phone system is in use by employee?

• Please detail any required ergonomic equipment

Workstation and Paperwork Areas

• Are all frequently accessed items within easy reach?

  Yes

  No

• Items relocated

• Does the employee have appropriate storage devices?

  Yes

  No

• Does the employee store away unrequired documents?

  Yes

  No

• Space cleared

• Does the employee have sufficient workspace for tasks?

  Yes

  No

• Does the workstation allow for the employees work flow/process?

  Yes

  No

• Workstation layout altered

• Are all cables and leads routed and secured?

  Yes

  No

• Cables re-positioned

• Please detail any required ergonomic equipment

• Does the employee have separate computer workstation and paperwork areas?

  Yes

  No

  N/A

• Does the employee require separate areas?

  Yes

  No

  N/A

• Workstation layout altered

• Is the lighting within the employees' workstation adequate?

  Yes

  No

  N/A

• Does the employee require a document holder?

  Yes

  No

• Document holder provided

• Document holder required

• When completing paperwork, does the employee reduce chair height to improve neck posture?

  Yes

  No

  N/A

• Education provided

• Please detail any required ergonomic equipment

Conclusion

• LHS Post-assessment

  Media

• Centre Post-assessment

  Media

• RHS Post-assessment

  Media

• Employee Signature:

  Sign