g Ergonomic Issue – Initial Employee Interview / Survey .
Identification Data Collection .
Name: Interviewer:
Dept: Date:
Job name / description:
Station or machine:
Comfort Survey----------------------------------------------------------------------------------------------------------------- --.
1. How long have you worked in this particular job?
< 1 month 1-12 months 1-5 years 5+ years
2. If you have recently started this job, have you worked on this specific job previously? When and for how
long, approximately? ___________________________________________________________________
3. As a result of doing this job, do you routinely experience discomfort or pain in your:
a. Fingers / Hands / Wrists No Left Right Day Night
b. Elbows No Left Right Day Night
c. Shoulders No Left Right Day Night
d. Neck / Upper Back No Yes Day Night
e. Lower Back No Yes Day Night
f. Legs / Knees / Feet No Yes Day Night
4. Have you ever visited the clinic for pain or injury in this job? No Yes
5. Have you ever had surgery or other medical treatment for
pain related to performing this job? No Yes
Operator Ideas .
6. What do you think is the worst part of this job (i.e., causes pain, least productive)? _________________
_______________________________________________________________________________________
7. What makes it the worst part / Why do you consider it the worst? ________________________________
_______________________________________________________________________________________
8. Describe any changes that have been made to improve this job. ________________________________
_______________________________________________________________________________________
9. What could be done to improve this job further?
Do you have a “quick fix” solution that will help resolve at least some of the problem? ______________
__________________________________________________________________________________
What other realistic solutions can you suggest the Ergonomics Committee pursue? ________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
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Table 1. Worksheet for NIOSH Lifting Calculator .
Example Position 1 Position 2 Position 3
Vertical Location (inches) 12”
Vertical Travel Distance (inches) 30”
Horizontal Location (inches) 20”
Angle of Asymmetry (degrees) 0º
Coupling (good, fair, poor) Fair
Frequency of Lifting (lifts/min.) 6 / min.
Load 18.5
Duration (≤ 1 hr, ≤ 2 hrs, ≤ 3 hrs) ≤ 1 hr
Recommended Weight Limit (lbs) 14 lbs.
Lifting Index (load / RWL) 1.1
Instructions: Coupling Table
Vertical Location = Height of the hands measured from the floor Good = Optimal design containers with handles of optimal
Vertical Travel Distance = Distance of the hands during lifting design, or irregular objects where the hand can be
Horizontal Location = Distance from the ankles to the load center easily wrapped around the object.
Angle of Assymetry = Angle between the assymetry line and the sagital line
Coupling = Hand-to-object gripping (see table at right)
Frequency = Average number of lifts per minute (over 15 minutes) Fair = Optimal design containers with handles of less than
Load = Weight of the object lifted, including container weight optimal design, optimal design containers with no
Duration = Short (lifting less than 1 hour with recovery time @ 1.2 X work time) handles or cut-outs, or irregular objects where the
Moderate (lifting between 1 & 2 hours with recovery time @ 0.3 X lifting time) hand can be flexed about 90°.
Long (lifting between 2 & 8 hours with standard industrial rest allowances)
Recommended Weight Limit = Will be calculated by NIOSH Calculator
Lifting Index = Will be calculated by NIOSH Calculator Poor = Less than optimal design container with no handles
or cut-outs, or irregular objects that are hard to
handle and/or bulky (e.g. bags that sag in the middle).
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