Summit Ergonomic Workstation Audit

• Office/Department

• Conducted on

  Date

• Prepared by

• Employee Name

• Time of audit.

  Date

• Photograph of the workstation area.

  Media

Scope of evaluation

• Why you are being evaluated

  Yes

  No

  N/A

• Are you experiencing any discomfort with your workstation?

  Yes

  No

  N/A

Personal information

• Supervisor Name

  Yes

  No

  N/A

• Height

  Yes

  No

  N/A

• Hand dominance

  Yes

  No

  N/A

• Job title

  Yes

  No

  N/A

• Work hours

  Yes

  No

  N/A

• Breaks in typical day

  Yes

  No

  N/A

Percent of time

• Computer

  Yes

  No

  N/A

• Keyboard

  Yes

  No

  N/A

• Mouse

  Yes

  No

  N/A

• Phone

  Yes

  No

  N/A

• Writing

  Yes

  No

  N/A

• 10 key

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Workstation Assessment

Chair

• Is the seating suitable and in good condition?

  Yes

  No

  N/A

• Are employees feet resting on floor or stable footrest

  Yes

  No

  N/A

• Able to adjust

  Yes

  No

  N/A

• Is there adequate space underneath the work surface for thighs,legs,and feet for employee to get close enough to the keyboard and input device?

  Yes

  No

  N/A

• If no, move materials out from under desk,raise keyboard tray,lower chair or raise workstation

  Yes

  No

  N/A

• Are thighs parallel to floor or hips slightly above knee?

  Yes

  No

  N/A

• If no adjust seat

  Yes

  No

  N/A

• Is seat pan wide enough to accommodate employee

  Yes

  No

  N/A

• Does seat pan fully support the thighs?

  Yes

  No

  N/A

• If no adjust seat pan so approximately 2" between calf and edge of seat

  Yes

  No

  N/A

• Is apex of the lumbar support at or slightly above employees belt line?

  Yes

  No

  N/A

• <br>If no adjust as needed

  Yes

  No

  N/A

• Is back rest tilt adjusted so employees trunk is approximately perpendicular to the floor?

  Yes

  No

  N/A

• If no adjust back rest forwards or backwards

  Yes

  No

  N/A

• Are employees shoulders relaxed and upper arms perpendicular to the floor?

  Yes

  No

  N/A

• If no adjust chair closer to workstation<br>

  Yes

  No

  N/A

• Are employees elbows free from contact with hard edges of arm rest?

  Yes

  No

  N/A

• If yes adjust armrest or remove

  Yes

  No

  N/A

Keyboard and mouse

• Are forearms parallel to the floor when typing?

  Yes

  No

  N/A

• If no adjust work surface height or keyboard and move mouse to same level as keyboard

  Yes

  No

  N/A

• Are wrists in a neutral position when keying?

  Yes

  No

  N/A

• If no adjust keyboard angle and provide wrist support as needed

  Yes

  No

  N/A

• If no consider larger or smaller input device

  Yes

  No

  N/A

• Are wrists free from contact with sharp edges when using input device and keyboard?

  Yes

  No

  N/A

• If no move keyboard or mouse to edge of work surface or provide a rest

  Yes

  No

  N/A

Monitor

• Is monitor facing directly in front of them?

  Yes

  No

  N/A

• If no move monitor in front of employee

  Yes

  No

  N/A

• Is top of the monitor at employees eye level?

  Yes

  No

  N/A

• If no adjust height account for bifocal or progressive lenses by moving monitor 2"-3"lower

  Yes

  No

  N/A

• If multiple monitors in use make sure same height

  Yes

  No

  N/A

• Monitor 18"-24" from eyes? Adjust as needed

  Yes

  No

  N/A

• Is monitor tilted so screen perpendicular to floor? Adjust as needed

  Yes

  No

  N/A

• Is monitor free from glare?

  Yes

  No

  N/A

• If no adjust blinds or provide anti-glare screen

  Yes

  No

  N/A

• Does the employee keep head in neutral position when entering from hard copy?

  Yes

  No

  N/A

• If no provide document holder at same height as monitor

  Yes

  No

  N/A

Telephone

• Does employee use hand free headset?

  Yes

  No

  N/A

• Is phone located in easy reach?

  Yes

  No

  N/A

Layout of work area

• Advised to reduce bending/twisting/overreaching?

• Heavy or frequently used items stored at or below waist height?

  Yes

  No

  N/A

Electrical safety

• Power and data leads safely positioned and bundled

  Yes

  No

  N/A

• Power outlets operating correctly?

  Yes

  No

  N/A

• Surge protectors used properly?

  Yes

  No

  N/A

Rest breaks

• Rest breaks are taken?

  Yes

  No

  N/A

• Stretching exercises though out the day?

  Yes

  No

  N/A

Indoor Enviroment

• Adequate and suitable lighting?

  Yes

  No

  N/A

• Glare levels minimalised

  Yes

  No

  N/A

• Adequate ventilation and airflow?

  Yes

  No

  N/A

• Temperature range comfortable?

  Yes

  No

  N/A

Audit required signatures.

• Employee signature.

  Sign

• Health and safety representative signature.

  Sign