The regulation sets out a framework for employers to avoid or reduce manual handling activity through a risk assessment process, which takes account of the risk factors detailed in the schedule. There is not currently a remote option under reason for request, so pmas technical coordinator will verify the nature of the request in the acknowledgement email. Work related injury is usually due to awkward posture, forceful movement, and external factors such as noise which can affect health and work output. Ergonomics in the workplace health and safety authority. Rula employee assessment worksheet original worksheet developed by dr. Workstation ergonomics selfassessment check the yes box beside each item once it has been achieved. The goal of this selfassessment is to help you set up your workstation for optimal comfort and. An atrisk ergonomic assessment requires the support and signature from a licensed physician m. Ergonomic evaluation report summary karen jones was evaluated on january 9, 2017 in response to reported mild discomfort of the upper back, right shoulder, and right upper arm. These workstation assessments are ideal for workers with symptoms, involved in physical and occupational therapy, and those who work in highrisk jobs such as data entry, materials handling, jobs with heavy or strenuous lifting. Product evaluation checklistssurveys for office, healthcare etc. Print as many copies as you like from the pdf file. Ergonomic assessment date activity assessed checklist.
Workstation ergonomic evaluation form british columbia. These risk factors mirror many of the ergonomic principles already described in this guidance leaflet. Health and safety executive ergonomics and human factors at work. Organizations that have identified possible wmsds should contact niosh for a health hazard evaluation hhe. The workplace ergonomic risk assessment wera, which is an observational tool was developed to provide a method of screening the working task quickly for exposure physical risk factor associated with workrelated musculoskeletal disorders wmsds1. Western university 2 rehabilitation services 2015 ds. High numbers may be because of the problems listed earlier andor dissatisfaction at work. The applied science that seeks to fit the job to the worker through the evaluation and design of the work environment in relation to human characteristics and interactions in the workplace. Our workplace assessment services range from highlevel prioritization surveys to detailed workplace improvements supported by risk analyses and cost justification data. Workspace worksurface yes no height allows you to position upper body shoulders.
Ergonomic assessment checklist date activity assessed risk ratting circle one organization point of contact high medium low personnel observed see notes on bottom of form to obtain the rating bldg nolocation roomarea ergonomic assessment checklist risk factors yes no 1. Workstation ergonomics self assessment computer workstation ergonomics. An ergonomic assessment is an evaluation to determine if a work station is appropriately set up for an individual to be able to work at their most optimal level throughout the day. The purpose of the evaluation is to provide guidance in workstation use to the employees and to enhance user comfort by correcting any workstation design defects identified. Is this assessment a preventative measure or related to a specific concern. Observed ratings for posture and force scores from forms lookup tables outputs. This assessment includes questions about areas of discomfort and produces recommended adjustments and trainings to help alleviate those areas of discomfort. Learn about ergonomic workstations, mobile devices, proper posture, stretching, and more. The employee reads, completes, and returns the atrisk ergonomic request form along with. An ergonomic assessment is crucial for the fitness of the workforce in an organization. The goal of this self assessment is to help you set up your workstation for optimal comfort and performance. Worker has adequate ergonomic equipment in working condition and is aware of how to make ergonomic adjustments to the equipment, as necessary, to. Ergonomics is the field of study that seeks to fit the job to the person, rather than the person to the job.
Check the yes box beside each item once it has been achieved. Ergonomic assessment checklists are tools used by competent professionals to identify risks of ergonomic injuries in the workplace. Seat height adjust height with both feet on the floor and thighs parallel to the. These 3 methods are integrated into 3 different applications from proplanner, and essentially take advantage of the process data available within those applications. Ergonomic evaluation office worker esh course 291ev, to workers slac training assessment sta for an office evaluation 3. The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. A brief questionnaire to evaluate the basic ergonomics of your computer workstation. This questionnaire is designed to help us help you adaptadjust your computer workstation and video display terminal vdt if needed to help prevent common stresses and discomforts associated with vdt usage. State employees can request a remote assessment using the same ergonomic intake form that is used for inperson assessments. Adjustable ergonomic chair adjustable keyboardmouse tray lumbar support cushion monitor riser foot rest. Implementing good practices promotes employee wellness, productivity, comfort and safety. National institutes of health, office of research services, division of occupational health and. If appropriate, the employee is directed to complete the ose2209 request for an atrisk ergonomic assessment. Ergonomic workspace assessment check the ergonomic fitness of your workstation.
Record any changes made, or key notes measurements for setting up your workstation in the future. Ergonomic risk factors were discussed and the worker is very aware of potential ergonomic risk factors and how to prevent musculoskeletal injury and how to work in a safe and healthy manner. Quick process assessment of ergonomics risk to entire body inputs. Workstation ergonomic assessment form revised jan 2018 uw safety office dept. The purpose of this toolkit is to provide resources that enable agencies, boards and commissions to reap the benefits of good office ergonomics. Fill out, securely sign, print or email your ergonomic assessment checklist occupational safety and health. Protective ergonomic assessments standard onsite risk assessment this is a more comprehensive evaluation. Ergonomic assessment assessment completed by sample report assessment completed at 3. Responses with an asterisk, require you to work with your supervisor to reduce ergonomic stresses. Since my ergonomic assessment, my job satisfaction has improved. Start a free trial now to save yourself time and money. The way we sit, stand and move at our computer workstation can have a direct correlation to back, neck, arm and hand injuries. Since my ergonomic assessment, i feel more productive at my workstation. National institutes of health, office of research services, division of occupational health and safety website.
A brief guide page 5 of 10 record and look at sickness absence and staff turnover levels. If the item is not applicable, record na in the yes column. Ergonomic assessment and analysis techniques available from proplanner proplanner provides 3 unique methods for ergonomic evaluation and assessment in the workplace. Lookup posture score in table a using values from steps. Ergonomic seating evaluation form web form ergonomic seating evaluation form pdf. Introduction an ergonomic evaluation of computer workstations was performed at the location on date. Page 1 of 3 laboratory ergonomics selfassessment checklist laboratory ergonomics selfassessment checklist use this checklist to evaluate your laboratory workstation. Office ergonomics workstation assessment worksheet. Ergonomics toolkit for supervisors and ergonomic assessors. Ergonomic specialist documents evaluation and recommendations in evaluation report. S895, office ergonomics assessment form, ergo, form, assessment, s895, workstation assessment created date. Submit paperless reports via weblink or pdf document. These records can be used to calculate incidence rates i. The composite ergonomic risk assessment a paperpencil method which is easy to use for anyone after some practice, and which gives a simple evaluation after a separate determination of the different ergonomic risks.
The purpose of the ergonomic evaluation form is to confirm that standard features of a computer workstation are evaluated to reduce the risk of injury andor. Performs evaluation at workers computer workstation. If the item is not applicable, record na in the yes. Office ergonomics preassessment survey this form must be completed before appointments can be booked. These factors can also have serious implications for an employees health since they put strain on the. Employees who feel the need for an ergonomic assessment can request one from their manager.
Observed ratings for posture and force scores from form s lookup tables outputs. An employee or their supervisor contacts the hr office to discuss the need for an ergonomic assessment. A workbook which allows detailed assessments and provide risk levels in borderline cases, according to. The extent of the service depends on the employees request or level of pain. Used during ergonomic assessments, ergonomic assessment checklists are designed to help ensure workers and their environments are maximized for comfort and productivity with minimal risk of a workrelated injury.