Title Page
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Site conducted
Department/Area
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Conducted on
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Prepared by
Findings
- Findings
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Category
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Primary Finding
- Down Too Low
- Up Too High
- Out of Reach
- Bend & Twist
- Over-Loaded
- Over & Over
- Cluttered
- Disorganized
- Dirty
- Off Course
- Lapsed
- Bending
- Reaching
- Walking
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Secondary Finding
- Down Too Low
- Up Too High
- Out of Reach
- Bend & Twist
- Over-Loaded
- Over & Over
- Cluttered
- Disorganized
- Dirty
- Off Course
- Lapsed
- Bending
- Reaching
- Walking
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Problem Description
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Solution Description
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Before Picture
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After Picture
Calculations (Will need to know how cost is calculated, but we should be able to help calculate cost of changes)
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Hours
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Available
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Steps per Day
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Minutes per Day
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Cost
