Checklist Ergonomics

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Ergonomics Checklist: General Workplace

Instructions: Please evaluate each item below and tick the appropriate box (Yes/No/N/A). Add comments where necessary to provide further detail on observations or proposed actions.

Date of Assessment: {{assessment_date}}

Assessor Name: {{assessor_name}}

Department/Area Assessed: {{department_area}}

Workstation Setup (Office Environment)

**Chair:**

Adjustable seat height, backrest, and armrests? [ ] Yes [ ] No [ ] N/A

Good lumbar support? [ ] Yes [ ] No [ ] N/A

Five-point star base with castors for stability? [ ] Yes [ ] No [ ] N/A

**Desk/Work Surface:**

Sufficient space for equipment and work materials? [ ] Yes [ ] No [ ] N/A

Adjustable height desk or appropriate height for user? [ ] Yes [ ] No [ ] N/A

No glare or reflections on the work surface? [ ] Yes [ ] No [ ] N/A

**Monitor:**

Top of monitor screen at or slightly below eye level? [ ] Yes [ ] No [ ] N/A

Arm's length distance from the user? [ ] Yes [ ] No [ ] N/A

Free from glare and reflections? [ ] Yes [ ] No [ ] N/A

**Keyboard and Mouse:**

Keyboard positioned to allow straight wrists? [ ] Yes [ ] No [ ] N/A

Mouse positioned close to the keyboard to avoid overreaching? [ ] Yes [ ] No [ ] N/A

Wrist rest used if needed, but not impeding movement? [ ] Yes [ ] No [ ] N/A

Manual Handling and Lifting

Are heavy objects stored between waist and shoulder height? [ ] Yes [ ] No [ ] N/A

Is lifting equipment (e.g., trolleys, hoists) available for heavy or awkward loads? [ ] Yes [ ] No [ ] N/A

Are employees trained in safe lifting techniques? [ ] Yes [ ] No [ ] N/A

Are routes for manual handling clear of obstructions? [ ] Yes [ ] No [ ] N/A

Lighting and Environment

Is lighting adequate for the tasks being performed (not too dim, not too bright)? [ ] Yes [ ] No [ ] N/A

Are there measures to control glare from windows or artificial lights? [ ] Yes [ ] No [ ] N/A

Is the temperature comfortable and ventilation adequate? [ ] Yes [ ] No [ ] N/A

Are noise levels acceptable for the tasks being performed? [ ] Yes [ ] No [ ] N/A

Work Practices and Breaks

Are employees encouraged to take short, frequent breaks from repetitive tasks? [ ] Yes [ ] No [ ] N/A

Are micro-breaks (e.g., stretching, looking away from screen) promoted? [ ] Yes [ ] No [ ] N/A

Is job rotation implemented for high-risk tasks to reduce exposure? [ ] Yes [ ] No [ ] N/A

Are employees aware of how to report discomfort or pain related to their work? [ ] Yes [ ] No [ ] N/A

Training and Awareness

Has ergonomic training been provided to all relevant employees? [ ] Yes [ ] No [ ] N/A

Are employees aware of the importance of good posture and ergonomic principles? [ ] Yes [ ] No [ ] N/A

Is information on ergonomic best practices readily available? [ ] Yes [ ] No [ ] N/A

Recommendations and Actions

Identified Issues/Concerns:

{{identified_issues}}

Recommended Actions/Corrective Measures:

{{recommended_actions}}

Responsible Person: {{responsible_person}}

Target Completion Date: {{target_completion_date}}

Completion Date: {{completion_date}}

Follow-Up Review

Date of Follow-up: {{follow_up_date}}

Reviewer: {{reviewer_name}}

Effectiveness of Implemented Actions: {{effectiveness_of_actions}}

Further Actions Required: {{further_actions_required}}

Declaration and Signatures

I hereby confirm that this ergonomic assessment has been completed to the best of my knowledge and that the recommendations will be considered/implemented as appropriate.

Assessor Signature: _________________________ Date: {{signature_date}}

Employee Representative Signature (if applicable): _________________________ Date: {{signature_date_employee}}