Office Ergonomic Assessor Worksheet MSC 2055 (6/15)



|[pic] |Office Ergonomic |[pic] |

| |Assessor Worksheet | |

|Instructions: Use this worksheet to document the workstation measurements, adjustments, and recommendations made to the workstation being assessed (refer to the |

|workstation measurement guidelines for assistance). |

|Date: |Agency: |Assessor name:       |Employee name:       |Job title: |

|      |      |Phone:       |Phone:       |      |

|Workstation type: | Systems (i.e., panel hung) Non-adjustable (i.e., wood or metal desk) |

| |Freestanding height adjustable Standing workstation |

|Work assessment (Use this section to determine how the employee splits up their day. Make sure you cover 100% of the day.) |

|Reviewed previous assessment:       |Dominant hand:       |Work schedule/shift:       |

|% of computer: |

|Workstation adjustments – Measurements are rounded to the nearest ½ inch. Always record measurements for future reference. |

|Employee measurements |Equipment measurements |Adjustment needed? |Describe adjustments, barriers to adjustment, and equipment|

| | | |changes needed: |

|Step 1 Knee to floor: |Seat height: | Yes No |      |

|      |      | | |

|Step 2 Popliteal length: |Seat depth and initial # finger spaces: | Yes No |      |

|      |      | | |

|Step 3 Seat pan width: Adequate Inadequate | Yes No |      |

|      | | |

|Step 4 Lumbar height: |Back rest lumbar height: | Yes No |      |

|      |      | | |

|Step 5 Elbow to floor (standing): |Writing surface height:       | Yes No |      |

|      | | | |

| |Keyboard height:       | | |

|Step 6 Elbow to floor (seated): |Writing surface height:       | |      |

|      | | | |

| |Keyboard height:       | | |

|Step 7 Eyebrow height: |Top of monitor screen height: | Yes No |      |

|      |      | | |

|Step 8 Distance to monitor: |Size of monitor screen measured diagonally: | Yes No |      |

|      |      | | |

|Step 9 Describe the placement of additional workstation items: |Adjustment needed? |Describe adjustments, barriers to adjustment, and equipment|

| | |changes needed: |

|Keyboard: Adequate Inadequate | Yes No |      |

|Pointing device: Adequate Inadequate | Yes No |      |

|Peripherals (i.e., phone/headset, copyholder, printer, shelves, task lighting): | Yes No |      |

|      | | |

|Additional comments (lighting, housekeeping [leg space, reaching], chair casters, |Summary of recommendations: |

|additional needs, etc.): |      |

|      | |

|Follow-up (follow up is recommended to ensure changes are kept or modified as necessary and once new equipment or changes are in place.) |

|Follow up: Two weeks One month |Date:       |Completed: Yes No |

|Additional follow up: Two weeks One month |Date:       |Completed: Yes No |

Office Ergonomic Assessor’s Workstation Measurement Guideline

Instructions: This sheet is designed to be used as a guideline to walk you, the assessor, through a workstation assessment and chair measurement process. Write your measurement results and comments on the front of this sheet. It’s recommended that you keep a copy of your assessments.

Assessment Preparation: Before conducting the actual assessment, introduce yourself; explain why you are doing the assessment, how the assessment information is used, and why it is important. You will need a tape measure. While taking the various measurements, you may need to touch the employee. If the employee is not comfortable with touching, then do your best to take the measurements without touching.

DESCRIPTION EXPLANATION EXAMPLE

|1 |Gather information about the job that the employee is performing. Review the |A Needs Assessment helps focus the assessor on the areas of the| |

| |items listed under “Needs Assessment” on the reverse side of this sheet. |employee’s job where the majority of time is spent. Ask the | |

| | |employee about the percentage of time spent in each area. | |

|2 |Have the employee sit at the workstation and visually show you his/her working |This is the starting point of the ergonomic assessment. As the | |

| |posture. After visually assessing the workstation, ask the employee questions |assessor you will need to look at how the entire workstation is| |

| |necessary to understand the work load, frequent movements, commonly used tools, |configured. Pay attention to the employee’s | |

| |etc. This information will help to determine what recommendations should be made.|posture and begin to think about changes that need to occur. | |

|3 |Knee to floor measurement: determine seat height and cylinder size. To take this |The knee-to-floor measurement is used to determine seat height | |

| |measurement, have the employee stand up and point at the top of the knee cap. |and cylinder size. Keep in mind that the cylinders also have | |

| |Measure from the top of the employee’s knee cap to the floor. Note: Be sure to |weight restrictions. The small/standard cylinder can | |

| |ask if the employee is wearing his/ her “normal” shoes. For example, if the |accommodate weight up to 250 lbs. The big and tall cylinder can| |

| |normal shoes are flat and high heels are being worn, your measurement will not be|accommodate weight from 250 lbs. up to 500 lbs. | |

| |accurate. | | |

|4 |Popliteal measurement: determine seat depth (the distance from the front of the |This measurement is used to determine the | |

| |chair to the back). This measurement is taken with the employee sitting in the |seat depth needed to fit the employee. | |

| |chair. Have the employee sit forward, away from the back of the chair. Have the | | |

| |employee place a pad of paper or a clipboard between the buttock and the back of | | |

| |the chair. When the employee sits back against the paper, take the measurement | | |

| |from the buttock to the back of the knee. | | |

|5 |Elbow to floor measurement: |This measurement is used to determine the proper keyboard and | |

| |Seated: determine keyboard and desk height. To take this measurement, the seat |desk height. Once the measurement has been taken, subtract 1-2 | |

| |height MUST first be adjusted to the correct height (see step #3). Once you have |inches to account for the keyboard tray. | |

| |adjusted |Change as necessary to obtain the neutral wrist posture. Work | |

| |the chair to the proper seat height, have the employee sit in the chair and bend |towards a flat or negative slope on the keyboard tray. | |

| |his/her elbow to a 90 degree angle (see picture). Measure from the employee’s |Employees requesting standing workstations need to identify | |

| |elbow to the floor. |what type of work will be performed while standing. | |

| |Standing: have employee stand and bend his/her elbow to a 90 degree angle. |If a keyboard tray is needed the work surface needs to be | |

| |Measure from the employee’s elbow to the floor. |adjusted accordingly. | |

|6 |Seat pan width measurement: determine how wide the seat should be. To take this |This measurement is used to determine how | |

| |measurement, have the |wide the seat must be to fit the employee. | |

| |employee sit in the chair with elbows bent at 90 degrees, palms facing down. | | |

| |Measure from smallest finger of the left hand to smallest finger of the right | | |

| |hand. | | |

|7 |Lumbar height measurement: determine how high the seat back should be. To take |The back of the chair has a lumbar curve | |

| |this measurement, have the employee sit forward in the chair. Have the employee |built into it. This curve must match with | |

| |place the back of his/her hand in the curve of the back. Measure from the middle |the natural curve of the lower back of | |

| |finger down to the top of the seat pan. This is the distance that the lumbar |the employee. | |

| |support of the chair must adjust to in order to support the employee’s lumbar | | |

| |curve. | | |

|8 |Check all the peripherals (phone, monitor, shelves, foot rests, floor mats, |The peripherals that are used in the workstation can cause many| |

| |etc.), to ensure that they are properly |issues for |[pic] |

| |set up. Finally, look at the lighting in the room to make |the employee. | |

| |sure it is appropriate. | | |

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