Summit Utilities Workstation Evaluation

• Summit Utilities Workstation Evaluation

• Employee name

• Conducted on

  Date
• Location
  Address

• Location

  Littleton Corporate Office

  Portland Corporate Office

  Yarmouth Corporate Office

• Prepared by

• Name of evaluator

  Janelle Underriner

  Bill Williams

• Supervisor

• Job Title

• Hand dominance

  Select Right Left

  • Right
  • Left

Scope of Evaluation

• Purpose of evaluations?

  Select New work station Employee requested Supervisor requested EHS Requested Other

  • New work station
  • Employee requested
  • Supervisor requested
  • EHS Requested
  • Other

• Other reason for evaluation

• Describe concerns or discomfort

• Pain level

• You may choose to photograph affected area

  Media

Photograph work station prior to adjustments

• Take required photograph

  Media

Chair Adjustments

• Employee has been informed about chair adjustments?

  Yes

  No

  N/A

• Chair height adjusted for upper body?

  Yes

  No

  N/A

• Shoulders in a neutral position?

  Yes

  No

  N/A

• Forearms parallel to the floor?

  Yes

  No

  N/A

• Forearms free of contact with desk edge?

  Yes

  No

  N/A

• Feet resting on the floor or a foot rest?

  Yes

  No

  N/A

• Provide a foot stool.

• Chair positioned to avoid over reaching?

  Yes

  No

  N/A

• Back support adjusted so trunk is perpendicular to the floor?

  Yes

  No

  N/A

• Lumbar support adjusted and adequate?

  Yes

  No

  N/A

• Provide or order a lumbar support if needed.

• Seat pan adjusted so thighs are parallel to the floor?

  Yes

  No

  N/A

Monitors

• Monitor heights adjusted so head is in a level/balanced position?

  Yes

  No

  N/A

• Monitors centered so employee does not turn head excessively?

  Yes

  No

  N/A

• Monitor distance is adjusted so employee is not leaning in to see?

  Yes

  No

  N/A

• Monitor screens are perpendicular to the floor?

  Yes

  No

  N/A

• Duel monitors are adjusted to same height?

  Yes

  No

  N/A

• Monitors are free from glare?

  Yes

  No

  N/A

• Order a non-glare screen cover.

• Document holder is provided if needed?

  Yes

  No

  N/A

Keyboard and Mouse

• Wrists are in a neutral position?

  Yes

  No

  N/A

• Wrists are supported if needed?

  Yes

  No

  N/A

• Keyboard design is adequate (not creating concerns)?

  Yes

  No

  N/A

• Order an ergonomic designed keyboard suitable for the issue.

• Mouse design is adequate (not creating concerns)?

  Yes

  No

  N/A

• Order and ergonomic design mouse suitable for the issue.

• Placement of keyboard and mouse reduce reaching?

  Yes

  No

  N/A

• Employee has been instructed to reduce pressure points?

  Yes

  No

  N/A

• Employee has been instructed to avoid tight grip on mouse (use light touch)?

  Yes

  No

  N/A

Telephone

• Telephone is within reach?

  Yes

  No

  N/A

• Hands free headset has been provided if needed?

  Yes

  No

  N/A

• Instruct employee to call 270 for Information Systems support to order head set.

Other

• Outlets and data leads are operating correctly?

  Yes

  No

  N/A

• Heavy items are stored at or below the waist?

  Yes

  No

  N/A

• Frequently used items are within reach?

  Yes

  No

  N/A

• Adequate space around legs exists beneath desk?

  Yes

  No

  N/A

• Lighting is adequate?

  Yes

  No

  N/A

• Employee has been advised to take micro breaks and stretch?

  Yes

  No

  N/A

Photograph work station after adjustments

• Take required photograph.

  Media

Signatures Required

• Employee signature

  Sign

• Evaluator signature

  Sign

Action Taken

• The following ergonomic items were provided:

  Select Chair was changed Lumbar support was added Document holder provided Monitor stands provided Foot stool provided

  • Chair was changed
  • Lumbar support was added
  • Document holder provided
  • Monitor stands provided
  • Foot stool provided

• Other/notes:

• Photograph items if you choose

  Media

• The following EHS personnel was notified

  Select Terry Wadding Tony Smith

  • Terry Wadding
  • Tony Smith

• Other action taken

Information provided to employee

• The following information was provided

  Select Link to video for lap top usage Work station stretches Key board short cuts for MS Word

  • Link to video for lap top usage
  • Work station stretches
  • Key board short cuts for MS Word

• Other/notes

Recommendations

• The following was recommended

  Select Report continued or increasing discomfort Request a headset if phone usage increases Request a document holder if entering data from copy Watch video on ergonomics for laptop usage

  • Report continued or increasing discomfort
  • Request a headset if phone usage increases
  • Request a document holder if entering data from copy
  • Watch video on ergonomics for laptop usage

• Other/notes

Follow Up

• Follow up with employee

  Tomorrow

  In one week

  In two weeks

  In one month