Discomfort Reported and Risk Factors Observed/Reported

/ Office Ergonomics Assessment Checklist
yorku.ca/ergo
Revision2013.05.29
Employee, Date: / Reviewer: Mike Papakyriakou

Discomfort Reported and Risk Factors Observed/Reported:

Some risk factors may be present at other times but only risk factors observed or reported by the employee during the assessment are checked off in the list below.

E=risk factor reported by employee, not observed;= corrected during assessment

ОHand/Wrist/Elbow: L R

ОMiddle finger hovering above mouse

ОWrist bending sideways (mouse, keyboard)

ОWrist bending up (mouse, keyboard, calculator)

ОHands NOT floating while typing

ОContact pressure: Wrist-desk, Elbow-armrest

ОAwkward grip (mouse, books, binders, files, stapler, staple remover, pen, smartphone/tablet)

ОSee Shoulder/Neck

ОOther:

ОShoulder/Neck: L R

ОHolding Telephone

ОReach for:

ОArmrests

ОMouse

ОKeyboard

ОNumber pad

ОCalculator

ОTelephone

ОItems on desk, shelves

ОIncreased reaches due to armrests hitting desk

ОElevating shoulders due to high armrests

ОForward head

ОChair backrest recline, screen position

ОLooking at:

ОKeyboard

ОPaper

ОScreen

ОPortable technology

ОVisitors

ОSee Eyes

ОSee Low Back

ОOther:

ОEyes: L R

ОGlare (direct, reflection)

ОScreen too bright or dim

ОScreen too high

ОScreen too far or close

ОSmall fonts on screen

ОPoor quality paper documents (e.g. handwritten, faint, small print)

ОLighting too bright or dark

ОOther:

ОLegs: L R

ОHitting knees on keyboard arm

ОHitting knees on obstructions under desk

ОSee Low back

ОOther:

ОLow back: L R

ОSeat too deep or shallow

ОSeat too high or low

ОFeet not supported

ОBackrest too high or low

ОBackrest too upright

ОNot using or insufficient lumbar support

ОSlouching

ОTwisting, bending, reaching, lifting, carrying

ОOther:

ОMore Details:

ОProlonged uninterrupted computer use

ОDid not know some important chair adjustments

ОDid not know some important desk adjustments

ОOther:

______

Next steps

Prioritize possible interventions before implementing. Many changes could be made however changing too many things at once can lead to confusion about what is helping and what is not.

ОSee attachedComputer Workstation Checklist

ОManagerReviewer will discussfindings

ОEmployeeReviewer will meet againon:

ОEmployee will return Ergonomics Change EvaluationToolto Manager on (or before):

ОEmployee will keep Manager updated on progress as outlined in theirWork Accommodation Plan