Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Pain/Stiffness?
Chair
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Seat Height
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Seat Back
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Seat Pan Depth
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Seat Pan Tilt
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Armrest Position
Keyboard and Mouse
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Keyboard Height
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Keyboard-to-User Distance
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Keyboard Slope
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Mouse-to-User Distance
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Mouse Height
Monitor
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Monitor Height
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Screen-to-User Distance
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Monitor Alignment with User
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Visual Comfort with Screen
Work Environment and Surface
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Leg Clearance at Workstation
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Placement of Frequently Used Items
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General Task Lighting
Work Practices
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Frequency of Microbreaks
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Keyboarding Posture
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Sitting Posture
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Phoning Posture
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Alternate Tasks
Evaluation Comments and Recomendations
Required Items to Achieve Safe Workstation Design
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Adjustable Ergonomic Chair
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Adjustable Keyboard/Mouse Tray
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Lumbar Support Cushion
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Monitor Riser
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Foot Rest
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Wristrest Pad
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Anti-glare Screen
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Reference Document Holder
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Telephone Headset
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Office Ergonomics Training
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Other
Review and Verification (The evaluator has reviewed neutral body position, safe workstation design, best work practices, and recommendations with the user.)
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Employee Signature
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Evaluator Signature
Ergonomic Evaluation Guidelines
Chair
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Seat Height - Adjust seat so feet are flat on the floor or footrest, knees are bent at right angles, and thighs are horizontal to the floor
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Seat Back - Adjust seat back so it supports the lumbar curve of the spine.
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Seat Pan Depth - Adjust the seat pan depth so the seat cushion is between one and four inches from the back of the knees.
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Seat Pan Tilt - Adjust seat pan tilt so hips and top of thighs are at right angles or greater.
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Armrest Position - Adjust armrests so they are out of the way during typing, but may provide support during other activities.
Keyboard and Mouse
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Keyboard Height - Adjust keyboard height so arms and forearms are at right angles or slightly greeter and forearms and hands form straight lines.
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Keyboard-to-User Distance - provide enough distance to allow user to relax shoulders with elbows hanging close to body.
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Keyboard Slope - Position keyboard at flat or slightly negative slope.
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Mouse-to-User Distance - Mouse should be directly next to keyboard.
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Mouse Height - Adjust mouse so it is as close to and on the same level as keyboard.
Monitor
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Monitor Height - Adjust monitor height so top of screen is at or slightly lower than eye level.
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Screen-to-User Distance - viewing distance is approximately arm's distance away (16"-28")
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Monitor Alignment with User - monitor and keyboard should be placed directly in front of user.
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Visual comfort of screen - monitor should be placed perpendicular to window or light source to avoid glare.
Work Environment and Surface
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Leg clearance at workstation - do not allow any contact between thighs and desk and allow room to move legs without contacting desk.
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Placement of frequently placed items - place with arms reach or as close as possible.
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General task lighting - ensure lighting is not direct or to bright
Work Practices
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Frequency of Microbreaks - get out of chair at least once per hour, microbreak every 30 minutes
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Keyboarding Posture - keep wrists straight, avoid supporting wrists on any surface while typing.
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Sitting Posture - upright or slightly reclined posture, maintain hollow in lower back.
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Phoning posture - avoid tilting head/neck to cradle phone. Use hand to hold receiver.
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Alternate tasks - break up long periods of continuous computer use by performing small tasks or errands.
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Photograph of Workstation
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Proper Workstation Setup
