Free Workplace Ergonomics Evaluation Form

Employee Name

Job Title

Department

Date of Evaluation

[Your Name]

[Your Job Title]

[Marketing]

[Month Day, Year]

Criteria

Yes

No

Comments

Is the desk height adjustable?

Is the chair height adjustable?

Is there sufficient legroom under the desk?

Are the desk and chair appropriately sized?

Is the computer monitor at eye level?

Is the keyboard and mouse within reach?

Are input devices (keyboard, mouse) ergonomic?

Is there proper lighting to reduce glare?

Criteria

Yes

No

Comments

Does the chair provide lumbar support?

Are armrests adjustable?

Is the chair comfortable for extended use?

Criteria

Yes

No

Comments

Is the monitor type suitable for the task?

Are monitor settings (brightness, contrast) adjusted properly?

Is the keyboard design ergonomic?

Is the mouse design ergonomic?

Criteria

Yes

No

Comments

Is natural lighting sufficient?

Is artificial lighting well-distributed?

Are measures taken to reduce glare?

Criteria

Yes

No

Comments

Is the workplace free from excessive noise?

Is the temperature comfortable for work?

Is ventilation adequate?

Is there access to sit-stand desks?

Are adjustable keyboard trays available?

Are wrist supports offered for computer use?

Recommendations

Priority

Responsible Party

Deadline

Implement ergonomic training sessions

HR Department

[Month Day, Year]

Purchase adjustable chairs for all workstations

Facilities Manager

[Month Day, Year]

Conduct a comprehensive lighting assessment

Health & Safety Committee

[Month Day, Year]

Establish a rotating task assignment system

Department Managers

[Month Day, Year]

Action Item

Status

Completion Date

Conduct ergonomic workshops

[Month Day, Year]

Review and update workstation arrangements

[Month Day, Year]

Distribute ergonomic guidelines to employees

[Month Day, Year]