COMPUTER WORKSTATION ASSESSMENT FORM
User Name: Department: Supervisor name:
Phone: Location: Phone:
How many hours per day are spent working on a computer? Description of Job Tasks: ____________________________________________________________ _________________________________________________________________________________
A.
Firm posture support: Does chair firmly support a comfortable upright posture, providing support to the lower back region and avoiding pressure on the back of the thighs? Yes No Recommendations: New chair adjustable for height and tilt of seatpan and backrest. Computer users should be able to adjust chairs from seated position without use of tools. Armrests, if provided, should be adjustable or removable. Another chair swapped from within the department. Lumbar support cushion if chair does not provide adequate lower back support Footrest if computer user’s feet do not rest firmly and comfortably on the floor Other, describe:
B. Work surface height: Does the height of the keyboard and pointing device allow the user’s forearms to be approximately parallel to the floor promoting a neutral/ flat position of the wrists? Yes No Recommendations: A height adjustable table A lower or higher table swapped from within the department A height adjustable keyboard tray that can be attached to an existing desk or table A chair that is height adjustable; may need to provide footrest Other, describe: C. Screen height: Is the top of the display screen at eye level, lower for bi-focal wearers? Yes No Recommendations: Raise monitor by putting it on top of hard disk drive, boxes or books Adjustable monitor arm Bi-level table adjustable for screen and keyboard height Lower monitor by removing it from hard disk drive or other platform Other, describe:
D.
Keyboard/Pointing Device: Alternative input devices may be helpful in promoting neutral (straight) wrist postures while typing and mousing, reduce awkward reaches to the mouse, and reduce force while typing or mousing.
Recommendations:
Alternative mouse Alternative keyboard Other, describe: E. Wrist support: Wrist rests may be helpful in promoting a neutral/flat (straight) position of the wrists while resting. Recommendations: Padded, movable wrist rest, same height as front of keyboard or pointing device Other, describe: F. Accessories: Workstation accessories may prevent awkward neck positions. Recommendations: Document holder adjustable to screen height Telephone headset Other, describe: G. Glare reduction: Elimination of glare helps to avoid eyestrain and awkward postures. Whenever possible, glare should be removed at the source. Use blinds or curtains over windows when necessary Reposition monitor to avoid direct light in user’s eyes or screen Position monitor screen at right angle to window Turn off some lights; use task lighting, if needed Remove some fluorescent bulbs, if necessary Use glare screen Other, describe: H. Other, describe:
Summary of Recommendations:
Target Date for Implementation: Evaluator’s signature:
Cc: Employee Employee’s supervisor Department’s Injury and Illness Prevention Program files
Date: