Office Ergonomic Evaluation

• Name of Client

• Department

• Building / Room Number / Office Phone Number
  Address

• Client's Supervisor

• Conducted on

  Date

• Evaluated by

• Average Daily PC Usage (hours/day)

• CTD Symptoms?

  Yes

  No

  N/A

• Follow-Up needed?

  Yes

  No

  N/A

• Comments / Client Complaint:

Chair Evaluation

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is the seat pan length appropriate?

  Yes

  No

  N/A

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?

  Yes

  No

  N/A

• Are the client's wrists straight and level?

  Yes

  No

  N/A

• Extension

• Flexion

• Ulnar Deviation

• Radial Deviation

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

  Yes

  No

  N/A

• Is the client's mouse location OK?

  Yes

  No

  N/A

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 Evaluation

• Is the monitor directly in front of the user?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is the screen free of glare and reflections?

  Yes

  No

  N/A

• Is the client's visual comfort OK?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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?

  Yes

  No

  N/A

Copyholder Recommendations

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

• Needs copy holder

• Other Recommendations

Phone Evaluation

• Is phone use OK?

  Yes

  No

  N/A

• Is phone use required while on PC?

  Yes

  No

  N/A

• Average Daily Phone Usage

Phone Recommendations

• Needs phone cradle device

• Needs speaker phone

• Needs headset

• Other recommendations

Work Habits Evaluation

• Are work habits OK?

  Yes

  No

  N/A

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 Evaluation

• Are awkward postures minimized?

  Yes

  No

  N/A

• Is back twisting minimized?

  Yes

  No

  N/A

• Can client avoid overhead reaches?

  Yes

  No

  N/A

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