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Name __________________________________ Date _____________________

JOB DESCRIPTION
Estimate percent of time spent

Reading:

Writing:

Computer:

Telephone:

Other (meetings, filing, stapling, copying):

Concerns/Issues:

 

CHAIR/SEATING

SAFE:
Yes

AT RISK:
No

1. Hips positioned at the back of chair with hips slightly higher than knees?

 

 

2. Upright seated posture with adequate back support?

 

 

3. Feet flat on floor or footrest with 2-3 fingers width between back of knees and front edge of seat pan?

 

 

4. Easy to maneuver chair within work area?

 

 

5. Is chair comfortable?

 

 

6. Clearance underneath desk for legs/feet?

 

 

MONITOR

SAFE:
Yes

AT RISK:
No

1. Height: eyes level with top 20% screen so it can be read without extending head/neck backwards?

 

 

2. Distance: approximately arms length from midline of body (approx.18-28”)?

 

 

3. Alignment: Is monitor directly in front of keyboard and chair when performing computer tasks so body, head and neck do not twist?

 

 

4. Is monitor screen easy to read? Clean? Glare-free?

 

 

5. Adequate lighting?

 

 

KEYBOARD & MOUSE

SAFE:
Yes

AT RISK:
No

1. Are wrists in a neutral (relatively straight) position while mousing and keyboarding?

 

 

2. Are shoulders relaxed with elbows close to sides while keyboarding and mousing (not stretched forward or out to side)?

 

 

3. Is there contact pressure at wrists or elbows during computer use from wrist rest or armrest of chair?

 

 

4. Is input device (mouse or trackball) beside keyboard so it can be operated without reaching?

 

 

5. Can mouse be controlled via shoulder motion rather than wrist/hand?

 

 

GENERAL WORKSTATION SET-UP

SAFE:
Yes

AT RISK:
No

1. Are frequently used items within easy reach such as mouse, telephone and keyboard?

 

 

2. Can telephone be used without bending head to the side or elevating shoulders when writing or using computer? Headset needed?

 

 

3. Is there a separate area for writing that does not involve reaching?

 

 

4. Is document holder (if used) at same height and distance as monitor screen so neck strain does not result? Is it large enough to hold documents?

 

 

5. Is the height of desk approximately elbow height when the chair is adjusted (standard 28-30’’)