ERGONOMIC ASSESSMENT

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

DAILY COMPUTER USAGE

• High Usage (5 to 8 hours a day)

• Moderate Usage (2 to 4 hours a day)

• Low Usage (Less that 2 hours a day)

• Is this workstation assigned to only one user?

  Yes

  No

  N/A

• Does the employee work in a cubicle?

  Yes

  No

  N/A

• Does the employee work in a private office?

  Yes

  No

  N/A

CHAIR

• Executive type

• Standard Office chair

• Other

• Chair is adjustable from a seated position?

  Yes

  No

  N/A

• Chair has adjustable or removable arm rests?

  Yes

  No

  N/A

• Chair has adjustable seat pan with waterfall edge?

  Yes

  No

  N/A

• Chair has swivel base with casters?

  Yes

  No

  N/A

• If chair is utilized on carpet is a chair mat provided for ease of movement?

  Yes

  No

  N/A

• Does chair back support lower back?

  Yes

  No

  N/A

SITTING POSTURE

• Employees head is in a neutral position while performing work / tasks?

  Yes

  No

  N/A

• Employees elbows are in close to their body while performing work / tasks?

  Yes

  No

  N/A

• Employees forearms parallel to the floor while performing work / tasks?

  Yes

  No

  N/A

• Is the height of the desk is at the proper height?

  Yes

  No

  N/A

• Enter the proper height to have work surface adjusted to (In inches)

• Employees wrists are neutral and straight while performing work / tasks?

  Yes

  No

  N/A

• Employees spine is in a neutral posture and has natural curve while performing work / tasks?

  Yes

  No

  N/A

• Employees hips are between 90-115 degree angle while performing work / tasks?

  Yes

  No

  N/A

• Employees knees are between 90-110 degree angle while performing work / tasks?

  Yes

  No

  N/A

• Employees feet are flat on the floor while performing work / tasks?

  Yes

  No

  N/A

• Is an adjustable foot rest available and utilized when needed?

  Yes

  No

  N/A

DESK

• Standard Office Desk

• System Furniture (Modular)

• Computer Table

• Does the work station have sharp edges?

  Yes

  No

  N/A

• Does the workstation have rounded edges?

  Yes

  No

  N/A

• Is the work station adjustable for both the keyboard and monitor(s)?

  Yes

  No

  N/A

• Does the work station have sufficient knee and leg room?

  Yes

  No

  N/A

KEYBOARD / MOUSE

• Keyboard is on top of desk.

• Keyboard is on articulating arm.

• Keyboard is located on sit / stand device.

• Keyboard is in front of employee?

  Yes

  No

  N/A

• Keyboard is flat? (If "No" lower the feet on the back of the keyboard)

  Yes

  No

  N/A

• Are keyboard and mouse wrist rests available and utilized?

  Yes

  No

  N/A

• If wrist rests are used do they keep the employees wrists in a neutral position?

  Yes

  No

  N/A

• Is the mouse the same height as the keyboard?

  Yes

  No

  N/A

• The employee is not currently suffering from any wrist, hand or elbow pain in either arm?

  Yes

  No

  N/A

MONITOR(S)

• One monitor

• Two monitors.

• More than two monitors.

• Are monitor(s) in front of the employee?

  Yes

  No

  N/A

• Are monitor(s) 18" to 24" away from the employees eyes?

  Yes

  No

  N/A

• Are monitor(s) adjustable?

  Yes

  No

  N/A

• Are the monitors adjusted so the employees eyes are in line with the top 1/3 of the monitor?

  Yes

  No

  N/A

COMPUTER LOCATION

• Located under the monitor(s).

• Located somewhere on the desk.

• Located on the floor to the side.

• Are all computer cables secured and not creating a trip hazard?

  Yes

  No

  N/A

WORK SURFACE

• Is the work stations work surface the appropriate height?

  Yes

  No

  N/A

• Is the employees work stations work surface free from clutter?

  Yes

  No

  N/A

• Are items that are frequently used within easy reach of an extended arm?

  Yes

  No

  N/A

TELEPHONE

• Telephone located on the desk to the left of the employee.

• Telephone located on the desk to the right of the employee.

• Is headset available and utilized?

  Yes

  No

  N/A

VISUAL COMFORT

• Does the employee wear eye glasses or contacts?

  Yes

  No

  N/A

• Employee wears eye glasses (Distance only).

• Employee wears eye glasses (Reading Only).

• Employee wears eye glasses (Bifocals).

• Employee wears eye glasses (Trifocals).

• Employee wears contacts.

• There is currently no glare on the monitor(s)

  Yes

  No

  N/A

• What is the employees dominant hand?

  Right

  Left

• What is the employees dominant eye?

  Right

  Left

• If needed is a document holder available?

• If a document holder is utilized is it on the dominant eye side and is the same height as the monitor(s)?

  Yes

  No

  N/A

NOTES / GENERAL RECOMMENDATIONS

• Is this ergonomic assessment free from recommendations?

  Yes

  No

  N/A

• Signature Of Employee Receiving Ergonomic Assessment

  Sign

• Signature Of Person Performing Ergonomic Assessment

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