Title Page
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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
Overview
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Picture
Job Title
Work Hours
Dominant Hand
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Discomfort associated with workstation
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Potential causes of discomfort as observed
Physical Demands of the job
Current Work Station
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Chair
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Keyboard
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Mouse
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Monitor
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Document Holder
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Telephone
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Other
Workstation Changes/Recommendations
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Chair
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Mouse
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Keyboard
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Monitor
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Document Holder
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Other