Office workstation ergonomic evaluation checklist
What does this form include?
This form contains 34 sections:
User concerns?
Chair
- Seat Height
- Seat Back
- Seat Pan Depth
- Seat Pan Tilt
- Armrest Position
Keyboard and Mouse
- Keyboard Height
- Keyboard-to-User Distance
- Keyboard Slope
- Mouse-to-User Distance
- Mouse Height
Monitor
- Monitor Height
- Screen-to-User Distance
- Monitor Alignment with User
- Visual Comfort with Screen
Work Environment and Surface
- Leg Clearance at Workstation
- Placement of Frequently Used Items
- General Task Lighting
Work Practices
- Frequency of Microbreaks
- Keyboarding Posture
- Sitting Posture
- Phoning Posture
- Alternate Tasks
Required Items to Achieve Safe Workstation Design
- Adjustable Ergonomic Chair
- Adjustable Keyboard/Mouse Tray
- Lumbar Support Cushion
- Monitor Riser
- Foot Rest
- Wristrest Pad
- Anti-glare Screen
- Reference Document Holder
- Telephone Headset
- Office Ergonomics Training
- Other
Employee Signature
Evaluator Signature
Seat Height - Adjust seat so feet are flat on the floor or footrest, knees are bent at right angles,
Seat Back - Adjust seat back so it supports the lumbar curve of the spine.
Seat Pan Depth - Adjust the seat pan depth so the seat cushion is between one and four inches from th
Seat Pan Tilt - Adjust seat pan tilt so hips and top of thighs are at right angles or greater.
Armrest Position - Adjust armrests so they are out of the way during typing, but may provide support
Keyboard Height - Adjust keyboard height so arms and forearms are at right angles or slightly greeter
Keyboard-to-User Distance - provide enough distance to allow user to relax shoulders with elbows hang
Keyboard Slope - Position keyboard at flat or slightly negative slope.
Mouse-to-User Distance - Mouse should be directly next to keyboard.
Mouse Height - Adjust mouse so it is as close to and on the same level as keyboard.
Monitor Height - Adjust monitor height so top of screen is at or slightly lower than eye level.
Screen-to-User Distance - viewing distance is approximately arm's distance away (16"-28")
Monitor Alignment with User - monitor and keyboard should be placed directly in front of user.
Visual comfort of screen - monitor should be placed perpendicular to window or light source to avoid
Leg clearance at workstation - do not allow any contact between thighs and desk and allow room to mov
Placement of frequently placed items - place with arms reach or as close as possible.
General task lighting - ensure lighting is not direct or to bright
Frequency of Microbreaks - get out of chair at least once per hour, microbreak every 30 minutes
Keyboarding Posture - keep wrists straight, avoid supporting wrists on any surface while typing.
Sitting Posture - upright or slightly reclined posture, maintain hollow in lower back.
Phoning posture - avoid tilting head/neck to cradle phone. Use hand to hold receiver.
Alternate tasks - break up long periods of continuous computer use by performing small tasks or erran
Photograph of Workstation
Proper Workstation Setup
Use this template