Individual Ergonomic Assessment - Parachute Consulting LLC

Date*

Time

:

Company*

Employee*

First Last

Date of Last Ergonomic Assessment

Leave blank if employee has never had an ergonomic assessment.

Dominant Hand*

Height*

Office Location*

Furniture

Desk at correct height?*

Keyboard tray - right height?*

Keyboard and mouse at the same level?*

Three-way adjustable chair? (Or ergonomic chair?)*

Chair adjusted as recommended?*

Recommendations for Furniture

Computer Equipment

Monitor at correct height and in front of the employee?*

What kind of mouse?*

Is this mouse adequate?*

Recommendations for computer equipment.

Accessories

Footrest?*

Anti-glare screen?*

Document holder?*

Mouse wrist pad?*

Keyboard wrist pad?*

Floor mat?*

Phone headset or headrest?*

Computer glasses needed?*

Recommendations for accessories.

General Office/Housekeeping

Bookshelves mounted safely to the wall?*

Electrical cords neatly wrapped together and out of the way?*

Phone close to employee for easy access?*

Clutter on the desk or workspace?*

Adequate workspace?*

Frequently used items are easily accessible?*

Recommendations for General Office/Housekeeping.

Workstation Setup Evaluation

Head

Is the employee's head directly over the shoulders?*

Does the employee's head face straight forward?*

Does the employee have to look down to see his/her work?*

If the employee is reading/writing, is his/her work tilted up to prevent the head from tipping forward?*

If the employee is performing data entry, is the document directly in front of him/her?*

Neck

Does the employee cradle a telephone on his/her shoulder?*

Is the employee's head tipped forward?*

Is the monitor at a height that keeps the employee's neck in a neutral position?*

Does the employee use bifocals or trifocals and tip his/her head back to focus?*

Shoulders

Are the employee's shoulders relaxed?*

Are the employee's upper arms next to the body?*

Does the employee have to reach for materials?*

Does the employee have to reach to operate equipment?*

Is the work surface at the correct height for the employee?*

Back

Does the chair provide good support to the employee's lower back?*

Is the chair adjustable and is it adjusted to support the employee correctly?*

Does the employee have to stand at a low work surface which causes him/her to have to bend forward?*

Does the employee have to move heavy materials?*

Arms and Wrists

Are the employee's forearms and wrists in a neutral position?*

Is the keyboard at the correct height and angle for the employee?*

Are the employee's arms supported by wrist rests or the chair arms?*

Is the arm supported when using the mouse?*

Legs and Feet

Are the employee's feet flat on the floor or a footrest*

Is there clearance under the work surface for the employee's legs?*

Does the chair put pressure on the back of the employee's lower legs?*

Eyes

At what distance is the monitor from the employee's eyes?*

Are the brightness and contrast controls for the monitor set for comfortable viewing?*

Is the screen clean?*

Is the employee's eyeglass/contacts prescription up to date?*

Is there reflected glare on the screen or surrounding flat surfaces?*

Is there direct glare from windows or bright light fixtures?*

Are ventilation ducts directed at the employee which may result in dry eyes?*

If the employee uses a document holder, is it at the same height and distance as the monitor?*

Recommendations for Workstation Set Up

Work Methods

Does this employee vary tasks throughout the day?*

Does the employee do some work standing as well as sitting?*

Is there an opportunity to rotate tasks to use different muscle groups?*

Does the employee take periodic breaks throughout the day to stretch?*

Does the employee know how to adjust his/her workstation to fit his/her body?*

Is the work station adjusted properly?*

What type of work does the employee do most? (data entry, word processing, etc)

How many hours per day does the employee spend on the computer (work and home)?

Employee Survey

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

Eye Strain/Sore Eyes/Blurry Vision*

Always
Often
Occasionally
Never

Neck*

Always
Often
Occasionally
Never

Shoulders*

Always
Often
Occasionally
Never

Arms*

Always
Often
Occasionally
Never

Elbows*

Always
Often
Occasionally
Never

Wrists/Hands*

Always
Often
Occasionally
Never

Upper Back*

Always
Often
Occasionally
Never

Lower Back*

Always
Often
Occasionally
Never

Hips*

Always
Often
Occasionally
Never

Knees*

Always
Often
Occasionally
Never

Lower legs*

Always
Often
Occasionally
Never

Ankles/Feet*

Always
Often
Occasionally
Never

For body parts with any discomfort or pain, list what the employee does for treatment (OTC medication, stretching, etc.)

Exercise/Activities

Home Office Setup

Do you carry a laptop home?

If you do carry a laptop home, how often?

Would you like a rolling bag for your laptop?

Overall Recommendations

Assessment End Time

Parachute Ergonomic Specialist