Computer Workstation Assessment Form
| Username: | Phone: |
| Department: | Location: |
| Supervisor Name: | Phone: |
| 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. |
| 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 |
Please print in landscape
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