How many hours per day are spent working on a computer:
Description of Job Tasks: (Hit "Tab" at
the end of each line)
A.
Firm posture support: Does chair firmly support
a comfortable upright posture, providing support to the lower back
region and avoiding pressure on the back of the thighs?
Yes
No
Recommendations:
New chair adjustable for height and tilt of seatpan and backrest.
Computer users
should be able to adjust chairs from
seated position without use of tools. Armrests, if provided, should
be adjustable or removable
Another chair swapped from within the department
Lumbar support cushion if chair does not provide adequate lower
back support
Footrest if computer user's feet do not rest firmly and comfortably
on the floor
Other, describe: (Hit "Tab" at the end of each line)
B.
Work surface height: Does the height of the
keyboard and pointing device allow the user's forearms to be approximately
parallel to the floor promoting a neutral/flat position of the wrists?
Yes
No
Recommendations:
A height adjustable table
A lower or higher table swapped from within the department
A height adjustable keyboard tray that can be attached to an existing
desk or table
A chair that is height adjustable; may need to provide footrest
Other, describe: (Hit "Tab" at the end of each line)
C.
Screen height: Is the top of the display screen
at eye level, lower for bi-focal wearers?
Yes
No
Recommendations:
Raise monitor by putting it on top of hard disk drive, boxes or
books
Adjustable monitor arm
Bi-level table adjustable screen and keyboard height
Lower monitor by removing it from hard disk drive or other platform
Other, describe: (Hit "Tab" at the end of each line)
D.
Keyboard/Pointing Device: Alternative
input devices may be helpful in promoting neutral (straight) wrist
postures while typing and mousing, reduce awkward reaches to the
mouse, and reduce force while typing or mousing.
Recommendations:
Alternative mouse
Alternative keyboard
Other, describe: (Hit "Tab" at the end of each line)
E.
Wrist support: Wrist rests may be helpful in promoting
a neutral/flat (straight) position of the wrists while resting.
Recommendations:
Padded, movable wrist rest, same height as front of keyboard or
pointing device
Other, describe: (Hit "Tab" at the end of each line)
F.
Accessories: Workstation accessories may prevent
awkward neck positions
Recommendations:
Document holder adjustable to screen height
Telephone headset
Other, describe: (Hit "Tab" at the end of each line)
G.
Glare reduction: Elimination of glare helps
to avoid eyestrain and awkward postures. Whenever possible, glare
should be removed at the source.
Use blinds or curtains over windows when necessary
Reposition monitor to avoid direct light in user's eyes or screen
Position monitor screen at right angle to window
Turn off some lights; use task lighting, if needed
Remove some fluorescent bulbs, if necessary
Use glare screen
Other, describe: (Hit "Tab" at the end of each line)
H.
Other, describe: (Hit "Tab" at the end
of each line)
Summary of Recommendations: (Hit "Tab" at
the end of each line)
Target Date for Implementation:
Evaluator's Signature:
Date:
CC:
Employee
Employee's supervisor
Department's Injury and Illness Prevention Program files
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