Free Ergonomics Inspection Form

1. Workplace Information

Company Name:

[Your Company Name]

Department/Area:

[Your Department/Area]

Date of Inspection:

[MM-DD-YYYY]

2. Employee Information

Employee Name:

[Employee’s Name]

Job Title:

[Employee’s Job Title]

Duration in Current Role:

[Duration]

3. Workstation Setup

Desk and Chair Alignment:

Are the desk height and chair position promoting a neutral body posture? 

Monitor Height and Distance:

Is the monitor at eye level and an arm's length away? 

Keyboard and Mouse Positioning:

Are the keyboard and mouse placed to allow relaxed shoulder and arm positions? 

4. Work Environment Factors

Lighting Quality:

Is the lighting adequate and glare-free?

Noise Levels:

Are the noise levels conducive to focused work without causing stress?

Air Quality and Temperature:

Is the air quality good, and is the temperature comfortable?

5. Physical Work Demands

Frequency of Breaks:

Are regular breaks taken to prevent strain?

Repetitive Motion Considerations:

Are tasks varied to reduce repetitive strain?

Lifting Techniques and Materials Handling:

Are proper techniques used for lifting and handling materials?

6. Ergonomic Risk Assessment

Potential Ergonomic Hazards Identified:

Observed risks include poorly adjusted chairs causing back strain, and low monitor height leading to neck discomfort.

Employee’s Posture and Movements:

The employee/[Employee Name] frequently leans forward, indicating the desk height may be too low. Also noted occasional slouching, suggesting inadequate back support.

Recommendations:

Consider adjusting the monitor height for [Employee Name] to reduce neck strain, as it is currently below eye level. Provide an ergonomic mouse and keyboard to reduce wrist strain, particularly for employees frequently typing.

7. Employee Wellness and Feedback

Comfort Level:

How comfortable do you feel in your current workstation setup? (Scale from 1-10)   

8

Physical Strain or Discomfort:

Have you experienced any physical strain or discomfort due to your workstation? 

If yes, please specify.

I often experience lower back pain, likely due to my chair.

Feedback and Suggestions:

(e.g., An ergonomic chair with better lumbar support might help. Having adjustable desks that allow for both sitting and standing work could improve comfort and flexibility.)