Name: | [Your Name] |
Department: | |
Job Title: | |
Email: | |
Contact Number: |
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: |
Chair Assessment | |
Chair Height: | Adjustable |
Back Support: | |
Armrests: | |
Desk and Monitor Assessment | |
Desk Height: | Adjustable |
Monitor Height: | |
Document Holder: |
Breaks and Movement | |
Break Schedule: | 5-minute break every hour |
Microbreaks | |
Stretching Exercises: | |
Keyboard and Mouse Usage | |
Typing Posture: | Wrists straight |
Mouse Placement: |
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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