Free Ergonomic Evaluation Template
Ergonomic Evaluation Form
This form is designed to assess the extent to which our work environment meets ergonomic standards. Under [YOUR COMPANY NAME], your comfort, safety, and productivity are at the forefront of our priorities. Your feedback is vital in highlighting potential hazards, ergonomic risk factors, and areas needing improvement.
Personal Information
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Name |
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Job Title |
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Department |
Evaluation Criteria
Please rate the following aspects of your work environment based on how comfortable, safe, and productive you feel.
Instruction:
Please provide an honest and comprehensive assessment during the specified evaluation period. Use the following scale to rate each competency:
1- Poor
2- Below Average
3- Average
4- Above Average
5- Excellent
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Evaluation Criteria |
Description |
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Workspace Layout |
The arrangement and organization of your workspace, including desk layout and accessibility. |
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Workstation Setup |
The ergonomic setup of your workstation, including chair, desk height, and monitor placement. |
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Equipment Ergonomics |
The ergonomic design and usability of equipment and tools used in your daily tasks. |
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Work Processes |
The efficiency and ergonomic considerations in your daily work processes and tasks. |
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Health and Safety Measures |
The presence and effectiveness of health and safety measures in your work environment. |
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Suggestions for Improvement
Please provide any specific areas of concern or suggestions for enhancing the ergonomic conditions of your work environment below:
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Area of Concern/ Suggestion |
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