• :
  • Leave blank if employee has never had an ergonomic assessment.
  • Furniture

  • Computer Equipment

  • Accessories

  • General Office/Housekeeping

  • Workstation Setup Evaluation

  • Head

  • Neck

  • Shoulders

  • Back

  • Arms and Wrists

  • Legs and Feet

  • Eyes

  • Work Methods

  • Employee Survey

    For each body part listed, check the frequency of discomfort, numbness, or pain.