Free Ergonomics Assessment Form Template
Ergonomics Assessment Form
This Ergonomics Assessment Form helps evaluate workstation setups and employee comfort. Use this form to detect ergonomic risks, evaluate practices, and make improvements. Fill out each section completely for a safe, efficient workplace.
Date of Assessment
Assessor’s Name
Employee Name
Job Title
Department
In Sections I-III, assess workstation setup, posture, and work patterns. Answer each item honestly, noting issues and suggestions to improve ergonomics and enhance workplace comfort and safety.
I. Workstation Setup
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Aspect |
Description |
Yes |
No |
Comments |
|---|---|---|---|---|
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Desk Height |
Desk height adjustable or fixed? |
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Chair |
Chair adjustable in height, backrest, and armrests? |
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Monitor Position |
Monitor at or slightly below eye level, at least an arm's length away? |
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Keyboard Position |
Keyboard positioned so that wrists are straight and hands are at or below elbow level? |
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Mouse Position |
Mouse positioned close to keyboard, within a comfortable reach, and with minimal force needed to click? |
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Footrest |
Footrest available and adjustable if needed to keep feet flat or supported? |
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Lighting |
Lighting adequate to prevent glare on screen and reduce eye strain? |
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Cable Management |
Cables and wires managed to avoid tangles and tripping hazards? |
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II. Posture and Comfort
|
Aspect |
Description |
Yes |
No |
Comments |
|---|---|---|---|---|
|
Seating Posture |
Seat depth adjustable to ensure backrest supports lumbar region and thighs are not restricted? |
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Back Support |
Chair provides adequate lumbar support and encourages a neutral spine position? |
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Arm Position |
Arms supported by armrests, with shoulders relaxed and elbows close to body? |
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Neck Position |
Head and neck aligned with spine, avoiding forward tilt or awkward angles? |
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Visual Strain |
Appropriate distance from screen, with regular breaks to reduce eye strain? |
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Seat Cushion |
Seat cushion adequate for comfort and support without causing pressure points? |
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Adjustability of Chair |
Chair adjustments (height, tilt, backrest) easy to operate and fit user's needs? |
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Foot Position |
Feet comfortably resting on the floor or footrest, with knees at approximately hip level? |
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III. Work Patterns
|
Aspect |
Description |
Yes |
No |
Comments |
|---|---|---|---|---|
|
Breaks |
Regular breaks taken to stretch and move, as per recommended guidelines (e.g., every 30-60 minutes)? |
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Repetitive Tasks |
Tasks performed with minimal repetition and variation, or use of ergonomic tools to reduce strain? |
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Adjustments |
Workstations adjusted to accommodate different tasks and ergonomic needs, with regular reviews? |
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Work Duration |
Duration of continuous work periods monitored to prevent long stretches without rest or change in activity? |
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Training |
Training provided on ergonomic practices and correct workstation setup? |
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Job Rotation |
Rotation of tasks or job roles to reduce repetitive stress and promote variety? |
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Tool and Equipment Use |
Use of ergonomic tools and equipment to facilitate better posture and reduce strain? |
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Feedback Mechanism |
System in place for employees to provide feedback on ergonomic issues and suggest improvements? |
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