Information

  • Plant

  • Conducted on

  • Prepared by

  • Location
  • Personnel

OBSERVER'S ASSESSMENT

BACK

  • When performing the task , is the back

  • almost neutral

  • back almost neutral.JPG
  • A1

  • moderately flexed or twisted or swide bent

  • back moderately flexed or twisted .JPG
  • A2

  • Excessively flexed or twisted or side bent?

  • back excessively flexed or twisted .JPG
  • A3

  • Add media

SEATING / STANDING TASK or LIFTING / PULLING / CARRYING

  • IS IT A SEATED OR STATIONARY TASK ?

  • Does the
    back remain in a static position most of the time?

  • NO

  • B1

  • YES

  • B2

  • Add media

  • LIFTING / PULLING / CARRYING TASK?

  • Is the movement of the back :

  • Infrequent (around 3 times per minute or less)?

  • B3

  • Frequent (around 8 times per minute)?

  • B4

  • Very frequent (around 12 times per minute or more)?

  • B5

  • Add media

SHOULDER / ARM

  • When the task is performed, are the hands

  • At or below waist height?

  • C1

  • At about chest height?

  • C2

  • At or above shoulder height?

  • C3

  • Add media

  • Is the shoulder/arm movement

  • Infrequent (some intermittent movement)?

  • D1

  • Frequent (regular movement with some pauses)?

  • D2

  • Very frequent (almost continuous movement)?

  • D3

  • Add media

WRIST / HAND

  • Is the task performed with

  • An almost straight wrist?

  • wrist straight.JPG
  • E1

  • A deviated or bent wrist?

  • wrist deviated or bent .JPG
  • E2

  • Add media

  • Are similar motion patterns repeated ?

  • 10 times per minute or less?

  • F1

  • 11 to 20 times per minute?

  • F2

  • More than 20 times per minute?

  • F3

  • Add media

NECK

  • When performing the task, is the head/neck
    bent or twisted?

  • No

  • G1

  • Yes, occasionally

  • G2

  • Yes, continuously

  • G3

  • Add media

WORKER'S ASSESSMENT

  • Is the maximum weight handled MANUALLY BY YOU in this task?

  • Light (5 kg or less)

  • H1

  • Moderate (6 to 10 kg)

  • H2

  • Heavy (11 to 20kg)

  • H3

  • Very heavy (more than 20 kg)

  • H4

  • Add media

  • On average, how much time do you spend per day on this task?

  • Less than 2 hours

  • J1

  • 2 to 4 hours

  • J2

  • More than 4 hours

  • J3

  • Add media

  • When performing this task, is the maximum force level exerted by one hand?

  • Low (e.g. less than 1 kg)

  • K1

  • Medium (e.g. 1 to 4 kg)

  • K2

  • High (e.g. more than 4 kg)

  • K3

  • Add media

  • At work do you drive a vehicle for

  • Less than one hour per day or Never?

  • M1

  • Between 1 and 4 hours per day?

  • M2

  • More than 4 hours per day?

  • M3

  • Add media

  • At work do you use vibrating tools for

  • Less than one hour per day or Never?

  • N1

  • Between 1 and 4 hours per day?

  • N2

  • More than 4 hours per day?

  • N3

  • Add media

  • Do you have difficulty keeping up with this work?

  • Never

  • P1

  • Sometimes

  • P2

  • Often

  • P3

  • Add media

  • In general, how do you find this job

  • Not at all stressful?

  • Q1

  • Mildly stressful?

  • Q2

  • Moderately stressful?

  • Q3

  • Very stressful?

  • Q4

  • Add media

  • Add media

  • Is the visual demand of this task

  • Low (almost no need to view fine details)?

  • L1

  • High (need to view some fine details)?

  • L2

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.