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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