Computer Workstation Ergonomic Self Assessment

• Inspected by

• Inspection Location

• Inspection Date

  Date

Chair

• Seat Height Adjustable

  Yes

  No

  N/A

• 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

• Seat Back Adjustable

  Yes

  No

  N/A

• Seat Back - Adjust seat back so it supports the lumbar curve of the spine.

• Seat Tilt Adjustable

  Yes

  No

  N/A

• Seat Pan Tilt - Adjust seat pan tilt so hips and top of thighs are at right angles or greater.

• Armrest Adjustable

  Yes

  No

  N/A

• Armrest Position - Adjust armrests so they are out of the way during typing, but may provide support during other activities.

Keyboard and Mouse

• Keyboard Height

  Safe

  At Risk

  N/A

• Keyboard Height - Adjust keyboard height so arms and forearms are at right angles or slightly greeter and forearms and hands form straight lines.

• Keyboard Distance

  Safe

  At Risk

  N/A

• Keyboard-to-User Distance - provide enough distance to allow user to relax shoulders with elbows hanging close to body.

• Mouse Placement

  Safe

  At Risk

  N/A

• Mouse Placement - Adjust mouse so it is as close to and on the same level as keyboard.

• Mouse Distance

  Safe

  At Risk

  N/A

• Mouse-to-User Distance - Mouse should be directly next to keyboard.

Monitor

• Monitor Height

  Safe

  At Risk

  N/A

• Monitor Height - Adjust monitor height so top of screen is at or slightly lower than eye level.

• Screen Distance

  Safe

  At Risk

  N/A

• Screen-to-User Distance - viewing distance is approximately arm's distance away (16"-28")

• Monitor Alignment with User

  Safe

  At Risk

  N/A

• Monitor Alignment with User - monitor and keyboard should be placed directly in front of user.

• Visual Comfort with Screen

  Safe

  At Risk

  N/A

• Visual comfort of screen - monitor should be placed perpendicular to window or light source to avoid glare.

Work Environment and Surface

• Leg Clearance at Workstation

  Safe

  At Risk

  N/A

• Leg clearance at workstation - do not allow any contact between thighs and desk and allow room to move legs without contacting desk.

• Placement of Frequently Used Items

  Safe

  At Risk

  N/A

• Placement of frequently placed items - place with arms reach or as close as possible.

• General Task Lighting

  Safe

  At Risk

  N/A

• General task lighting - ensure lighting is not direct or to bright

Work Practices

• Frequency of Microbreaks

  Yes

  No

  N/A

• Frequency of Microbreaks - get out of chair at least once per hour, microbreak every 30 minutes

• Keyboarding Posture

  Safe

  At Risk

  N/A

• Keyboarding Posture - keep wrists straight, avoid supporting wrists on any surface while typing.

• Sitting Posture

  Safe

  At Risk

  N/A

• Sitting Posture - upright or slightly reclined posture, maintain hollow in lower back.

• Phoning Posture

  Safe

  At Risk

  N/A

• Phoning posture - avoid tilting head/neck to cradle phone. Use hand to hold receiver.

• Alternate Tasks

  Yes

  No

  N/A

• Alternate tasks - break up long periods of continuous computer use by performing small tasks or errands.

Required Items to Achieve Safe Workstation Design

• Adjustable Ergonomic Chair

  Yes

  No

  N/A

• Adjustable Keyboard/Mouse Tray

  Yes

  No

  N/A

• Lumbar Support Attachment

  Yes

  No

  N/A

• Monitor Riser

  Yes

  No

  N/A

• Foot Rest

  Yes

  No

  N/A

• Mouse Pad

  Yes

  No

  N/A

• Reference Document Holder

  Yes

  No

  N/A

• Telephone Headset

  Yes

  No

  N/A

• Office Ergonomics Training

  Yes

  No

  N/A

• Other

Review and Verification (The evaluator has reviewed neutral body position, safe workstation design, best work practices, and recommendations with the user.)

• Employee Signature

  Sign

• Evaluator Signature

  Sign