Workplace Ergonomics Evaluation Form
Workplace Ergonomics Evaluation Form
Please provide detailed feedback to help us enhance your workspace and well-being. Thank you.
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Employee Name |
Job Title |
Department |
Date of Evaluation |
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[Your Name] |
[Your Job Title] |
[Marketing] |
[Month Day, Year] |
Workstation Setup
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Criteria |
Yes |
No |
Comments |
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Is the desk height adjustable? |
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Is the chair height adjustable? |
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Is there sufficient legroom under the desk? |
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Are the desk and chair appropriately sized? |
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Is the computer monitor at eye level? |
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Is the keyboard and mouse within reach? |
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Are input devices (keyboard, mouse) ergonomic? |
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Is there proper lighting to reduce glare? |
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Seating
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Criteria |
Yes |
No |
Comments |
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Does the chair provide lumbar support? |
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Are armrests adjustable? |
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Is the chair comfortable for extended use? |
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Computer Equipment
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Criteria |
Yes |
No |
Comments |
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Is the monitor type suitable for the task? |
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Are monitor settings (brightness, contrast) adjusted properly? |
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Is the keyboard design ergonomic? |
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Is the mouse design ergonomic? |
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Work Habits
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Criteria |
Yes |
No |
Comments |
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Is natural lighting sufficient? |
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Is artificial lighting well-distributed? |
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Are measures taken to reduce glare? |
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Environmental Factors
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Criteria |
Yes |
No |
Comments |
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Is the workplace free from excessive noise? |
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Is the temperature comfortable for work? |
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Is ventilation adequate? |
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Additional Considerations
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Criteria |
Yes |
No |
Comments |
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Are employees provided with ergonomic chairs? |
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Is there access to sit-stand desks? |
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Are adjustable keyboard trays available? |
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Are wrist supports offered for computer use? |
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Recommendations and Action Plan
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Recommendations |
Priority |
Responsible Party |
Deadline |
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Implement ergonomic training sessions |
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HR Department |
[Month Day, Year] |
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Purchase adjustable chairs for all workstations |
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Facilities Manager |
[Month Day, Year] |
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Conduct a comprehensive lighting assessment |
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Health & Safety Committee |
[Month Day, Year] |
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Establish a rotating task assignment system |
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Department Managers |
[Month Day, Year] |
Follow-Up
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Action Item |
Status |
Completion Date |
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Conduct ergonomic workshops |
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[Month Day, Year] |
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Review and update workstation arrangements |
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[Month Day, Year] |
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Distribute ergonomic guidelines to employees |
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[Month Day, Year] |
