Ergonomic Evaluations

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Yes

  No

  N/A

Input Devices

• Forearms parallel to floor?

  Yes

  No

  N/A

• Wrists straight and level, in a neutral position?

  Yes

  No

  N/A

• Mouse location next to keyboard?

  Yes

  No

  N/A

• Keying/mouse grip force OK?

  Yes

  No

  N/A

• Wrists straight and not bent left or right?

  Yes

  No

  N/A

• Wrists flat and not bent up or down?

  Yes

  No

  N/A

• Input device(s) height is at or just below the elbows?

  Yes

  No

  N/A

• Is current keyboard a standard model?

  Yes

  No

  N/A

• Is input device a standard mouse?

  Yes

  No

  N/A

Monitor

• Is monitor directly in front of the user?

  Yes

  No

  N/A

• Is the viewing distance OK relative to size of the monitor?

  Yes

  No

  N/A

• Is viewing height OK relative to the size of the monitor?

  Yes

  No

  N/A

• Is the screen free of glare or reflection?

  Yes

  No

  N/A

• Visual comfort OK?

  Yes

  No

  N/A

• Is there more than one monitor? If yes, enter number.

  Yes

  No

  N/A

• What is the current size and types of the monitor(s)?

Copyholder

• Is a copyholder currently in use?

  Yes

  No

  N/A

• What is the current type of copyholder?

Phone

• Is the phone within easy reach?

  Yes

  No

  N/A

• Is the phone used when user is on the PC?

  Yes

  No

  N/A

• Is there a headset?

  Yes

  No

  N/A

• Does user use speakerphone?

  Yes

  No

  N/A

• What is the average daily use of the phone?

Work Habits

• Does user change positions regularly?

  Yes

  No

  N/A

• Are work habits OK?

  Yes

  No

  N/A

• Does the user take short breaks?

  Yes

  No

  N/A

• Is user wearing a wrist brace or other device? Is device physician approved?

  Yes

  No

  N/A

Office/ Workstation Arrangement

• Are awkward positions minimized?

  Yes

  No

  N/A

• Is back twisting minimized?

  Yes

  No

  N/A

• Is there adequate room for accessories and documents?

  Yes

  No

  N/A

• Are frequently used items within easy reach?

  Yes

  No

  N/A

• Are cables and cords concealed or out the way?

  Yes

  No

  N/A

Comments?

• Additional comments?