Specialist Ergonomic Evaluation and Recommendations

• Conducted on

  Date

• Name

• Location
  Address

• Ergo Contact

Evaluation

• Observation

  Media

• Reason For Review

  Select New Onset Discomfort Extensive History - Flare UP Move - Initial Set Up - 1 m Move - With in 3 months Move - With in 6 months Move - 1 + Years Follow UP Specialist Requested - Unknown Annual/Scheduled Review

  • New Onset Discomfort
  • Extensive History - Flare UP
  • Move - Initial Set Up - 1 m
  • Move - With in 3 months
  • Move - With in 6 months
  • Move - 1 + Years
  • Follow UP
  • Specialist Requested - Unknown
  • Annual/Scheduled Review

• 1 hour Body Mechanics Training Completed

Desk

• Is a surfboard being used?

  Yes

  No

  N/A

• Sit/ Stand desk - used correctly?

  Yes

  No

  N/A

• Is there adequate space?

  Yes

  No

  N/A

• Is a keyboard trey being used?

  Yes

  No

  N/A

• Is the height appropriate for the employee?

  Yes

  No

  N/A

• Behavior Observed

  Select Awkward Posture Inadequate Suport Contact Stress Excessive Force Multiple Complaints of Discomfort Behavior and Technique Frequency and Duration

  • Awkward Posture
  • Inadequate Suport
  • Contact Stress
  • Excessive Force
  • Multiple Complaints of Discomfort
  • Behavior and Technique
  • Frequency and Duration

• Risk Potential

  Select High Risk Factor Exposure Injury Statistics Personal Risk Factors

  • High Risk Factor Exposure
  • Injury Statistics
  • Personal Risk Factors

• Additional Information

Chair

• Current Equipment

• Is it properly sized?

  Yes

  No

  N/A

• Is it working properly?

  Yes

  No

  N/A

• Does it need adjustments?<br>

  Yes

  No

  N/A

• Behavior Observed

  Select Awkward Posture Inadequate Suport Contact Stress Excessive Force Multiple Complaints of Discomfort Behavior and Technique Frequency and Duration

  • Awkward Posture
  • Inadequate Suport
  • Contact Stress
  • Excessive Force
  • Multiple Complaints of Discomfort
  • Behavior and Technique
  • Frequency and Duration

• Risk Potential

  Select High Risk Factor Exposure Injury Statistics Personal Risk Factors

  • High Risk Factor Exposure
  • Injury Statistics
  • Personal Risk Factors

• Follow Up in Lab Requested

• Additional Information

Keyboard

• Current Equipment

• Behavior Observed

  Select Awkward Posture Inadequate Suport Contact Stress Excessive Force Multiple Complaints of Discomfort Behavior and Technique Frequency and Duration

  • Awkward Posture
  • Inadequate Suport
  • Contact Stress
  • Excessive Force
  • Multiple Complaints of Discomfort
  • Behavior and Technique
  • Frequency and Duration

• Risk Potential

  Select High Risk Factor Exposure Injury Statistics Personal Risk Factors

  • High Risk Factor Exposure
  • Injury Statistics
  • Personal Risk Factors

• Audit Information

  Select Roller Mouse Wrist aids

  • Roller Mouse
  • Wrist aids

• Follow Up in Lab Requested

• Additional Information

Mouse

• Current Equipment

• Behavior Observed

  Select Awkward Posture Inadequate Suport Contact Stress Excessive Force Multiple Complaints of Discomfort Behavior and Technique Frequency and Duration

  • Awkward Posture
  • Inadequate Suport
  • Contact Stress
  • Excessive Force
  • Multiple Complaints of Discomfort
  • Behavior and Technique
  • Frequency and Duration

• Risk Potential

  Select High Risk Factor Exposure Injury Statistics Personal Risk Factors

  • High Risk Factor Exposure
  • Injury Statistics
  • Personal Risk Factors

• Audit Information

  Select Roller Mouse Wrist aids

  • Roller Mouse
  • Wrist aids

• Follow Up in Lab Requested

• Additional information

Monitors

• Were adjustments made for corrective lenses?

  Yes

  No

  N/A

• Monitor Arms Broken?

  Yes

  No

  N/A

• Need 2nd Monitor

  Yes

  No

  N/A

• Need adjustments?

  Yes

  No

  N/A

• Behavior Observed

  Select Awkward Posture Inadequate Suport Contact Stress Excessive Force Multiple Complaints of Discomfort Behavior and Technique Frequency and Duration

  • Awkward Posture
  • Inadequate Suport
  • Contact Stress
  • Excessive Force
  • Multiple Complaints of Discomfort
  • Behavior and Technique
  • Frequency and Duration

• Risk Potential

  Select High Risk Factor Exposure Injury Statistics Personal Risk Factors

  • High Risk Factor Exposure
  • Injury Statistics
  • Personal Risk Factors

• Additional Information

Ergonomic Recommendations

• Specialist recommendations may not be altered or changed.

• EMERGE TICKET Desk Adjustments - Operations & Maintenance New Furniture/Surplus Furniture PLEASE COPY AND PASTE RECOMMENDATIONS in additional comments

• Keyboards, Mice and Accessories Links provided offer discounted prices specifically for the Brookhollow Ergonomic Program. You are not obligated to purchase from these companies. Please do not purchase refurbished or used products Logitech T650 Touch Pad drivers are available in Programs - see SETPOINT 6.0

• Carla Jean (C.J) Wilkinson
  Ergonomic Specialist - Brook hollow Campus
  carla.j.wilkinson@exxonmobil.com
  Office: 832-624-4991
  Cell: 832-683-2357

• Sign