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Ergonomics Powered By Docstoc
					                             OFFICE ERGONOMICS WORKSTATION EVALUATION
  The purpose of the evaluation is to focus on ergonomics issues of the workstation, work practices, and work
  process to offer reasonable suggestions to help improve comfort, safety, and productivity in the workplace.

                                                     Background Information
                     Demographics                             Work Activity          %       Reason for Assessment
Evaluated by                                               Computer                      New employee
                                                                                         New workstation
Eval Date                                                  Telephone                     Medical issue
Last Name                                                  Handwriting                   Equipment/furniture issue
                                                                                         Other (comment below)
First Name                                                 10 key
Job Title                                                  Read-hard copy
Dept                                                       Meetings
Location                                                   Other
Stature (shoeless)                                         Work Activity Comments               Other Information
Heel height
Handedness            Right/Left/Ambidextrous
Job demands           Sedentary/Manual
Work hours            Full/Part time
User                  Single/Multi
Vision                No correction//Reading/Distance/Bi/trifocal/Computer/Contacts
                Chair                        Issue                 Comment                       Recommendation
Chair ID                                      No       Chair fit/adjustment OK            None
                                              Yes      Chair not properly adjusted        Chair adjusted with instructions
Legs            4 / 5 / 6                              Back support not OK                 provided
Casters         Carpet/Hard surface                    Armrests not OK                    Replace chair - refer to
                                                       Chair too small                     Recommended Specifications
Seatpan         Ht/Tilt/Tension/Slide                                                      Repair chair (comment)
                                                       Chair too large
Back            Ht/Angle                               Maintenance issue (comment)        Other (comment)
                                                       Other (comment)
Armrest         Ht/Side/Rotate
Fit             OK No/Yes
Maint Issue     No/Yes

            Worksurface                      Issue                 Comment                       Recommendation
Config          Straight/Corner/              No       Worksurface is appropriate         None.
                L-shape/U-shape               Yes      Worksurface is too low             Lower worksurface - see
                                                       Worksurface is too high             Recommended Specifications
Type            Fixed/Adjust                           Worksurface does not have          Raise worksurface - See
Height          Sit/Stand:    (        “)               enough work area.                   Recommended Specifications.
                                                       Other (comment)                    Reorganize to provide additional
                                                                                            worksurface area.
                                                                                           Other (comment)
    Foot support/clearance              Issue                 Comment                         Recommendation
Feet            Dangling/Supported/      No         Foot support is appropriate         None.
                Clearance                Yes        Feet dangling – not supported       Add footrest
                                                    Inadequate foot/knee clearance      Lower worksurface - see
Footrest        No/Yes
                                                    Other (comment)                      Recommended Specifications
                                                                                         Raise worksurface - See
                                                                                          Recommended Specifications.
                                                                                         Remove foot/knee obstruction
                                                                                         Other (comment)

            Keyboard Tray               Issue                 Comment                         Recommendation
Tray            No/Yes                   No         Keyboard tray appropriate           None
                                         Yes        Keyboard tray limits reach          Adjusted keyboard tray position
Ht adjust       No/Yes                               access to worksurface                and provided user instruction
Ang adjust      No/Yes                              Keyboard tray type does not         Remove tray - place keyboard
                                                     allow neutral arm/hand position      directly on worksurface
Size fits       Keyboard only                       Keyboard tray location does not     Other (comment)
                Keyboard-mouse                       allow neutral hand/arm position
                                                    Other (comment)

              Keyboard                  Issue                 Comment                         Recommendation
Type            Straight/Curved/         No         Keyboard type and location          None
                Articulated/Other        Yes         appropriate                         Adjusted keyboard position and
                                                    Keyboard type does not allow         provided user instruction
Location        Work surface/Tray                    neutral arm/hand position           Replace keyboard - see
Shortcuts       Used: No/Yes                        Keyboard location does not allow     comments
                                                     neutral hand/arm position           Add gel keyboard wrist rest
Maint           No/Yes                              No wrist rest in use for support    Other (comment)
                                                    Other (comment)

               Mouse                    Issue                 Comment                         Recommendation
Type            Shell/Rollerball/        No         Mouse type and location             None
                Vertical/Joystick/       Yes         appropriate                         Adjusted mouse position and
                Touchpad/Other                      Mouse type does not allow            provided user instruction
                                                     neutral arm/hand position           Replace mouse - see comments
Location        Work surface/Tray
                                                    Mouse location does not allow       Remove mouse wrist rest
Scroll          No/Yes                               neutral hand/arm position           Other (comment)
                                                    Mouse wrist rest in the way
Maint           No/Yes
                                                    Other (comment)

              Computer                  Issue                 Comment                         Recommendation
Type            Desktop/Laptop           No         Computer type and location are      None
                                         Yes         appropriate                         Reposition computer out of way
Location        Work surface/Floor                  Computer in the way                 Other (comment)
                                                    Other (comment)

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              Monitor                  Issue                  Comment                        Recommendation
Type           CRT/LCD                  No         Monitor type and location          None
                                        Yes         appropriate                        Adjusted monitor position and
Number         Single/Dual/More                    Monitor too low                     provided user instruction
Adjustable     No/Yes                              Monitor too high                   Adjusted monitor resolution and
Stand                                              Monitor too close                   provided user instruction
                                                   Monitor too far away               Add monitor riser (comment)
Resolution     OK No/Yes
                                                   Monitor resolution not             Other (comment)
Position       OK No/Yes                            appropriate.
                                                   Other (comment)

         Document holder               Issue                  Comment                        Recommendation
Holder         No/Yes                   No         No document holder in use - not    None
                                        Yes         needed                             Add landscape holder between
Type           Portrait/Landscape                  No document holder in use -         keyboard and monitor
Location       Side/Front                           awkward head/neck position         Add landscape holder off to side
                                                   Other (comment)                     of monitor
                                                                                       Add portrait holder between
                                                                                        keyboard and monitor
                                                                                       Add portrait holder off to side of
                                                                                       Other (comment)

             Telephone                 Issue                  Comment                        Recommendation
Type           Handset/Headset/         No         Telephone type and location        None
               Speaker                  Yes         appropriate                        Add headset to allow for hands-
                                                   Telephone located in awkward        free operation
Location       Left/Right                           position                           Reposition telephone to left side
                                                   Awkward head/neck position with     worksurface
                                                    handset use                        Reposition telephone to right
                                                   Other (comment)                     side worksurface
                                                                                       Other (comment)

              Storage                  Issue                  Comment                        Recommendation
Desktop        OK No/Yes                No         Adequate desktop and file          None
                                        Yes         storage                            Housecleaning to provide
File           OK No/Yes                           Limited desktop storage             additional desktop storage
                                                   Limited file storage               Housecleaning to provide
                                                   Other (comment)                     additional file storage
                                                                                       Add additional file storage
                                                                                       Other (comment)

           Illumination                Issue                  Comment                        Recommendation
Overhead       OK No/Yes                No         Ambient and task lighting          None
                                        Yes         appropriate                        Lower ambient light level
Task           OK No/Yes                           Ambient light level too high       Raise ambient light level
                                                   Ambient light level too low        Add desktop task light
                                                   Task lighting too high.            Decrease desktop task light
                                                   Task lighting too low              Other (comment)
                                                   Other (comment)

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                Other                 Issue                 Comment                           Recommendation
                Other                 Issue                 Comment                           Recommendation

                                   Recommended Specifications (inches)
              Seating System                     Worksurface Height                               Computer
1. Seatpan height:                      6. Writing/reading desk                   7. Keyboard height:
2. Seatpan depth:                                                                 8. Mouse height:
3. Seatpan width:                                                                 9. Monitor height:
4. Armrest height:                                                                10. Monitor distance:
5. Armrest width:

   1. Seatpan height is measured as the distance from the floor to the seatpan (at the side of the seatpan) with the
       user in the chair. Seatpan height is based on stature considering the height of the shoe heels.
   2. Seatpan depth is measured as the distance from the back support to the front of the seatpan and allows for 1.5
       to 2” of space between the back of the knee and front of the seatpan.
   3. Seatpan width is measured as the distance side-to-side of the seatpan and allows for 1.5 to 2” of space between
       the thigh and side of the seatpan.
   4. Armrest height is measured as the distance from the top of the armrest to the floor.
   5. Armrest width is measured as the distance between the outside edges of the armrest.
   6. Worksurface height (writing/reading desk) is measured as the distance from the floor to the top surface of the
   7. Keyboard height is the distance from the floor to the top surface of the platform that the keyboard rests on. (It is
       not to the top of the keyboard.)
   8. Mouse height is the distance from the floor to the top surface of the platform that the mouse rests on. (It is not to
       the top of the mouse.)
   9. Monitor height is height from the floor to the top of the monitor screen (not the top of the monitor bezel.)
   10. Monitor distance is from the eye position (bridge of the nose between the eyes) to the screen.

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