Faculty & Staff

Computer Workstation Assessment Form

Username: Phone:
Department: Location:
Supervisor Name: Phone:
How many hours per day are spent working on a computer:
Description of Job Tasks: (Hit "Tab" at the end of each line)

A. Firm posture support: Does chair firmly support a comfortable upright posture, providing support to the lower back region and avoiding pressure on the back of the thighs?
Yes       No  
Recommendations:
New chair adjustable for height and tilt of seatpan and backrest. Computer users
      should be able to adjust chairs from seated position without use of tools. Armrests, if provided, should be adjustable or removable
Another chair swapped from within the department
Lumbar support cushion if chair does not provide adequate lower back support
Footrest if computer user's feet do not rest firmly and comfortably on the floor
Other, describe: (Hit "Tab" at the end of each line)
    
    
B. Work surface height: Does the height of the keyboard and pointing device allow the user's forearms to be approximately parallel to the floor promoting a neutral/flat position of the wrists?
Yes       No  
Recommendations:
A height adjustable table
A lower or higher table swapped from within the department
A height adjustable keyboard tray that can be attached to an existing desk or table
A chair that is height adjustable; may need to provide footrest
Other, describe: (Hit "Tab" at the end of each line)
    
    
C. Screen height: Is the top of the display screen at eye level, lower for bi-focal wearers?
Yes       No  
Recommendations:
Raise monitor by putting it on top of hard disk drive, boxes or books
Adjustable monitor arm
Bi-level table adjustable screen and keyboard height
Lower monitor by removing it from hard disk drive or other platform
Other, describe: (Hit "Tab" at the end of each line)
    
    
D. Keyboard/Pointing Device: Alternative input devices may be helpful in promoting neutral (straight) wrist postures while typing and mousing, reduce awkward reaches to the mouse, and reduce force while typing or mousing.
Recommendations:
Alternative mouse
Alternative keyboard
Other, describe: (Hit "Tab" at the end of each line)
    
    
E.

Wrist support: Wrist rests may be helpful in promoting a neutral/flat (straight) position of the wrists while resting.
Recommendations:
Padded, movable wrist rest, same height as front of keyboard or pointing device
Other, describe: (Hit "Tab" at the end of each line)
    
    

F. Accessories: Workstation accessories may prevent awkward neck positions
Recommendations:
Document holder adjustable to screen height
Telephone headset
Other, describe: (Hit "Tab" at the end of each line)
    
    
G. Glare reduction: Elimination of glare helps to avoid eyestrain and awkward postures. Whenever possible, glare should be removed at the source.
Use blinds or curtains over windows when necessary
Reposition monitor to avoid direct light in user's eyes or screen
Position monitor screen at right angle to window
Turn off some lights; use task lighting, if needed
Remove some fluorescent bulbs, if necessary
Use glare screen
Other, describe: (Hit "Tab" at the end of each line)
    
    
H. Other, describe: (Hit "Tab" at the end of each line)
  Summary of Recommendations: (Hit "Tab" at the end of each line)
 
Target Date for Implementation:
 
Evaluator's Signature: Date:
CC:

Employee
Employee's supervisor
Department's Injury and Illness Prevention Program files

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