Workplace Ergonomics Review Form
Workplace Ergonomics Review Form
Please complete this form thoroughly to ensure a comprehensive evaluation.
REVIEWER INFORMATION |
|
Reviewer Name |
Mikey Goldberg |
Professional Background |
[Your Professional Background] |
Contact Information |
[Your Phone Number] |
Date of Assessment |
[MM/DD/YYYY] |
EMPLOYEE INFORMATION |
|
Employee Name |
Jane Smith |
Job Title |
Project Manager |
Department |
Marketing |
WORKSTATION SETUP |
|
Aspect |
Review |
Chair Type |
Ergonomic office chair |
Chair Height |
[Employee Chair Measurement] |
Desk Type |
[Employee Desk Type] |
Desk Height |
[Employee Desk Height] |
Monitor Placement |
[Angle and Distance from Monitor] |
Keyboard and Mouse Position |
[Alignment with Standards] |
Lighting |
[Workstation Lighting Condition] |
EMPLOYEE ASSESSMENT |
||
Aspect |
Items |
Assessment |
Posture and Movement |
Sitting/Standing Posture |
Good sitting posture |
Required Movements |
[Comfort Description] |
|
Health and Comfort Concerns |
Existing Health Issue(s) |
[List Health Issue(s) if any] |
Specific Discomfort Areas |
[Details of Discomfort] |
RECOMMENDATIONS |
|
Recommendation |
Details |
Workstation Adjustments |
Adjust chair height, add lumbar support |
Thank you for completing this form. For further assistance or clarification, contact the [Designated Personnel/Department] at [Designated Personnel/Department Phone] or email at [Designated Personnel/Department Email].