Workplace Ergonomic Risk Identification Form
WORKPLACE ERGONOMIC RISK IDENTIFICATION FORM
Employee Details
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Name: |
[Your Name] |
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Department: |
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Job Title: |
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Email: |
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Contact Number: |
Workstation Information
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Workstation Setup |
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Type of Workstation: |
Desk |
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Chair Type: |
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Computer Monitor(s): |
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Keyboard and Mouse: |
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Workspace Layout |
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Arrangement of Equipment: |
Dual monitors side by side, keyboard and mouse centered |
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Space Utilization: |
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Ergonomic Equipment and Accessories
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Chair Assessment |
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Chair Height: |
Adjustable |
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Back Support: |
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Armrests: |
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Desk and Monitor Assessment |
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Desk Height: |
Adjustable |
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Monitor Height: |
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Document Holder: |
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Employee Habits and Work Practices
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Breaks and Movement |
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Break Schedule: |
5-minute break every hour |
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Microbreaks |
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Stretching Exercises: |
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Keyboard and Mouse Usage |
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Typing Posture: |
Wrists straight |
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Mouse Placement: |
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Ergonomic Risk Assessment
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Physical Discomfort |
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Reported Discomfort: |
Occasional neck pain |
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Affected Body Parts: |
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Risk Level Assessment |
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Overall Risk Level: |
Medium |
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Specific Risks: |
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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].
