• Average Daily PC Usage (hours/day)

  • CTD Symptoms?

  • Follow-Up needed?

  • Comments / Client Complaint:


Chair Evaluation

  • Are the client's feet flat on the floor when seated?

  • Are the client's upper legs parallel to the floor when seated?

  • Is the client's lower back supported when seated?

  • Is the seat pan length appropriate?

Chair Recommendations

  • Foot Rest

  • Raise Chair

  • Lower Chair

  • Adjust back rest, seat pan and/or arm rests

  • Evaluate alternate chair

  • Other Recommendations


Keyboard/Hand Evaluation

  • Are the client's forearms parallel to the floor?

  • Are the client's wrists straight and level?

  • Extension

  • Flexion

  • Ulnar Deviation

  • Radial Deviation

  • Is the client's keying/mouse grip force OK?

  • Is the client's mouse location OK?

Keyboard Recommendations

  • Raise Keyboard

  • Lower Keyboard

  • Adjust keyboard incline angle

  • Needs adjustible keyboard/mouse platform

  • Needs wrist rest

  • Evaluate ergonomic keyboard

  • Position mouse next to keyboard and at same height

  • Needs mouse wrist rest

  • Evaluate mouse hardware change

  • Other Recommendations

Computer Monitor

Computer Monitor Evaluation

  • Is the monitor directly in front of the user?

  • Is the monitor viewed at a distance between 16-24 inches?

  • Is the top of the screen slightly below the seated eye level?

  • Is the screen free of glare and reflections?

  • Is the client's visual comfort OK?

  • Is the client's eyeglass/bifocal prescription OK?

Computer Monitor Recommendations

  • Reposition monitor

  • Lower monitor

  • Raise monitor

  • Adjust monitor tilt angle

  • Reposition entire PC work station

  • Close curtains, window blinds

  • Lower overall office lighting level

  • Add task lighting

  • Refocus on distant objects (30 seconds every 30 minutes)

  • Change screen colors to provide better contrast (dark letters on a light colored background is preferred)

  • Other Recommendations


Copyholder Evaluation

  • Is copyholder use OK?

Copyholder Recommendations

  • Position copy holder at same height and viewing distance as monitor

  • Needs copy holder

  • Other Recommendations


Phone Evaluation

  • Is phone use OK?

  • Is phone use required while on PC?

  • Average Daily Phone Usage

Phone Recommendations

  • Needs phone cradle device

  • Needs speaker phone

  • Needs headset

  • Other recommendations

Work Habits

Work Habits Evaluation

  • Are work habits OK?

Work Habits Recommendation

  • Mini-breaks (2-3 minutes every 45 minutes of PC work)

  • Alternate between typing and non-typing work

  • PC break software

  • Other Recommendations

General Office

General Office Evaluation

  • Are awkward postures minimized?

  • Is back twisting minimized?

  • Can client avoid overhead reaches?

General Office Recommendations

  • Lower desk work surface height

  • Needs adjustable height workstation

  • Change office layout

  • Reposition notebook, books, etc.

  • Change drawer/shelf location

  • Other Recommendations

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