Workplace Ergonomics Audit Form

WORKPLACE ERGONOMICS AUDIT FORM

Department/Location: Headquarters

Audit Date: [Month Day Year]

Date of Previous Audit (if applicable): 2052-12-15

Instructions:

Please provide accurate information to improve the well-being of your employees. Your input is vital for creating a safe and comfortable work environment. Thank you for your cooperation.

Seating

Yes

No

Is the chair provided adjustable for height, backrest, and armrests?

Are employees provided with footrests if needed?

Computer Equipment

Is the computer monitor at eye level and directly in front of the employee?

Is the keyboard and mouse positioned to allow a natural wrist position?

Are glare-reducing measures in place to prevent eye strain?

Workspace Layout

Is there adequate lighting in the workspace?

Are there any tripping hazards, clutter, or obstructions in the workspace?

Is there sufficient space for employee movement and adjustments?

Ergonomic Training

Have employees received ergonomic training?

Is information on proper ergonomics available to employees?

Employee Feedback

Have employees reported discomfort or pain related to their workstation?

If yes, were actions taken to address their concerns?

Recommendations and Action Plan

List any recommendations or actions needed to improve ergonomics in the workplace:

__________________________________________________________________________________

__________________________________________________________________________________

Date for Follow-up Audit: [Month Day Year]

Audit Conducted By:

[Your Name]

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