Individual Ergonomics Evaluation

  • Individual Ergonomics Evaluation

  • Today's Date*
     - -
  • Initial Ergonomics Evaluation*
  • Reason for Evaluation*
  • Area of discomfort/pain*

  • Workstation Analysis

  • Which hand(s) do you use to control your mouse?*
  • Mouse*
  • Which hand(s) do you type with?*
  • Keyboard*
  • Desk (main workstation)*
  • Chair*
  • Screen Setup*
  • Location of Work Space*
  • Other Accessories*

  • Typical Work Routine

  • Do you perform repetitive tasks? (Repetition is 100 reps per hour to 200 per day.)*
  • Does your daily routine require repeated heavy lifting? (Over 50 lbs.)*
  • Does your daily routine require extreme reaching?*
  • Does your daily routine require either sitting or standing for an extended period of time? (1-3 hours.)*
  • Does your daily routine require awkward back angles held for extended periods of time? (1-3 hours.)*
  • Does your daily routine require awkward elbow angles held for extended periods of time? (1-3 hours.)*
  • Does your daily routine require awkward wrist flexion angles held for extended periods of time? (1-3 hours.)*
  • Does your daily routine require awkward wrist extension angles held for extended periods of time? (1-3 hours.)*
  • Does your daily routine require awkward back or hip flexion angles held for extended periods of time? (1-3 hours.)*
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  • Please book an appointment with Monique, our Benefits Administrator, to further discuss and get next steps using the following link:

    BOOK HERE!

  • HR Assessment

  • Today's Date*
     - -
  • Potential postural issues - Desk (Surface should be 25in - 27in above the floor and 30 in deep.)*
  • Potential postural issues - Chair (Chair should be 18in W, 15in L, base 24in around, and breathable fabric with back rest at least 18in tall, 14in W.)*
  • Potential postural issues - Screens (18-30in away from eye view, top of line display should be slightly below the eye level, tilted slightly to reduce reflection and glare, clean and free of debris.)*
  • Potential postural issues - Keyboard, including laptop keyboard (Detached keyboards should be sloped at about 10-15 degrees, wrists should be relaxed and straight or parallel armrest elbows at 90 degree angle, and easily within reach.)*
  • Potential postural issues - Mouse (Wrists should be relaxed and straight or parallel armrest elbows at 90 degree angle, same level as the keyboard, and easily within reach.)*
  • Potential lighting issues*
  • Changes made during evaluation*
  • Educational materials provided*
  • Product recommendations*
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