WORKPLACE ERGONOMIC RISK IDENTIFICATION FORM
Employee Details
Name: | [Your Name] |
Department: | |
Job Title: | |
Email: | |
Contact Number: | |
Workstation Information
Workstation Setup |
Type of Workstation: | Desk |
Chair Type: | |
Computer Monitor(s): | |
Keyboard and Mouse: | |
Workspace Layout |
Arrangement of Equipment: | Dual monitors side by side, keyboard and mouse centered |
Space Utilization: | |
Ergonomic Equipment and Accessories
Chair Assessment |
Chair Height: | Adjustable |
Back Support: | |
Armrests: | |
Desk and Monitor Assessment |
Desk Height: | Adjustable |
Monitor Height: | |
Document Holder: | |
Employee Habits and Work Practices
Breaks and Movement |
Break Schedule: | 5-minute break every hour |
Microbreaks | |
Stretching Exercises: | |
Keyboard and Mouse Usage |
Typing Posture: | Wrists straight |
Mouse Placement: | |
Ergonomic Risk Assessment
Physical Discomfort |
Reported Discomfort: | Occasional neck pain |
Affected Body Parts: | |
Risk Level Assessment |
Overall Risk Level: | Medium |
Specific Risks: | |
This Workplace Ergonomic Risk Identification Form is an essential tool to assess and mitigate ergonomic risks. It helps in creating a comfortable and safe working environment for our employees.
For any questions or concerns, please contact [Your Company Name] at [Your Company Email] or [Your Company Number].
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