Information
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Plant
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Conducted on
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Prepared by
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Location
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Personnel
OBSERVER'S ASSESSMENT
BACK
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When performing the task , is the back
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almost neutral
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A1
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moderately flexed or twisted or swide bent
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A2
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Excessively flexed or twisted or side bent?
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A3
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SEATING / STANDING TASK or LIFTING / PULLING / CARRYING
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IS IT A SEATED OR STATIONARY TASK ?
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Does the
back remain in a static position most of the time? -
NO
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B1
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YES
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B2
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LIFTING / PULLING / CARRYING TASK?
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Is the movement of the back :
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Infrequent (around 3 times per minute or less)?
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B3
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Frequent (around 8 times per minute)?
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B4
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Very frequent (around 12 times per minute or more)?
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B5
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SHOULDER / ARM
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When the task is performed, are the hands
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At or below waist height?
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C1
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At about chest height?
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C2
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At or above shoulder height?
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C3
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Is the shoulder/arm movement
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Infrequent (some intermittent movement)?
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D1
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Frequent (regular movement with some pauses)?
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D2
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Very frequent (almost continuous movement)?
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D3
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WRIST / HAND
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Is the task performed with
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An almost straight wrist?
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E1
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A deviated or bent wrist?
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E2
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Are similar motion patterns repeated ?
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10 times per minute or less?
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F1
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11 to 20 times per minute?
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F2
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More than 20 times per minute?
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F3
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NECK
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When performing the task, is the head/neck
bent or twisted? -
No
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G1
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Yes, occasionally
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G2
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Yes, continuously
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G3
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WORKER'S ASSESSMENT
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Is the maximum weight handled MANUALLY BY YOU in this task?
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Light (5 kg or less)
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H1
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Moderate (6 to 10 kg)
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H2
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Heavy (11 to 20kg)
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H3
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Very heavy (more than 20 kg)
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H4
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On average, how much time do you spend per day on this task?
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Less than 2 hours
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J1
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2 to 4 hours
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J2
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More than 4 hours
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J3
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When performing this task, is the maximum force level exerted by one hand?
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Low (e.g. less than 1 kg)
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K1
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Medium (e.g. 1 to 4 kg)
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K2
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High (e.g. more than 4 kg)
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K3
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At work do you drive a vehicle for
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Less than one hour per day or Never?
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M1
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Between 1 and 4 hours per day?
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M2
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More than 4 hours per day?
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M3
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At work do you use vibrating tools for
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Less than one hour per day or Never?
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N1
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Between 1 and 4 hours per day?
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N2
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More than 4 hours per day?
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N3
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Do you have difficulty keeping up with this work?
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Never
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P1
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Sometimes
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P2
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Often
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P3
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In general, how do you find this job
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Not at all stressful?
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Q1
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Mildly stressful?
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Q2
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Moderately stressful?
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Q3
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Very stressful?
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Q4
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Is the visual demand of this task
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Low (almost no need to view fine details)?
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L1
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High (need to view some fine details)?
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L2