Leavitt Ergonomic Assessment Tool

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Seating

• Chair selection appropriate for task (executive or conference room chairs not used for long periods)?

  Yes

  No

  N/A

• Chair has at least 5 points of adjustment?

  Yes

  No

  N/A

• Seating height is adjusted high enough to allow arms to rest at side while typing?

  Yes

  No

  N/A

• Armrests are removed or adjusted to lowest level?

  Yes

  No

  N/A

• Employee instructed not to rest arms on desk, armrest or any other surface while typing or on phone?

  Yes

  No

  N/A

• Employee instructed on why seating adjustment and use is important?

  Yes

  No

  N/A

• Is the lumbar support adjusted? Users should be instructed to alternate from sitting back to sitting up throughout the shift.

  Yes

  No

  N/A

• Is foot rest required/used?

  Yes

  No

  N/A

• Is lumbar support required? If so, was it discussed with individual?

  Yes

  No

  N/A

Workstation Arrangement

• Primary and secondary reach zones assessed and explained? ( Note: devices used frequently should remain in primary reach zone.)

  Yes

  No

  N/A

• Can the user stand periodically throughout the shift?

  Yes

  No

  N/A

• Is area under desk clear?

  Yes

  No

  N/A

Monitor

• Is monitor at arms length away, tilted to reduce glare and top of monitor adjusted to slightly below eye level? (Note: monitor adjust must take into account corrective vision/glasses)

  Yes

  No

  N/A

• If dual monitors are used is the user centered on the monitor used the most to minimize neck twisting? (Note: sometime the use is 60/40 or 70/30. In these cases set the user the same with the primary monitor 60-70% in front of the user.)

  Yes

  No

  N/A

Phone

• If phone is used more than 10 minutes per hour is hands-free device used?

  Yes

  No

  N/A

Lighting

• Is lighting adequate for task and placed in position as to not cause glare?

  Yes

  No

  N/A

Temperature / Noise

• Is temperature adjusted to a level that doesn't require coats/jackets or scarves? (Note: coats or sweaters on chairs indicate possible temperature challenges.)

  Yes

  No

  N/A

• Is cross-chatter minimized?

  Yes

  No

  N/A

Stretching

• Stretches displayed?

  Yes

  No

  N/A

• Stretches encouraged throughout shift?

  Yes

  No

  N/A

Intervention

• Are employees trained and encouraged to report aches/pains early?

  Yes

  No

  N/A

• Are employees trained on ergonomics periodically (at least annually)?

  Yes

  No

  N/A