Computer Workstation Ergonomic Self-evaluation Survey

This self-evaluation survey is intended for use by employees to complete a self-assessment for potential ergonomic risk factors at their workstation.

If you have questions about the self-evaluation survey, if any of the “No” boxes are checked, or if you want to request an ergonomic evaluation of your workstation, please inform your supervisor. Supervisors can contact EH&S at ext. 4-6778 or advise the requesting employee to contact EH&S to request an ergonomic evaluation.

Component	Adjustment	Yes	No	N/A
COMPUTER WORKSTATION ERGONOMIC SELF-EVALUATION SURVEY
1. Keyboard and Mouse
Keyboard height	Keyboard height is adjusted so arms and forearms are at right angles or slightly greater and forearms and hands form straight lines so wrists are in a neutral position. With shoulders relaxed and fingers curved, the home row of keys (row starting with “A”) is at the same height as elbows or slightly below elbows.
Keyboard-to-employee distance	Keyboard-to-employee distance allows employee to relax shoulders with elbows hanging close to body while comfortably sitting in the chair using the chair back for lumbar support.
Keyboard slope	Keyboard is positioned so it is flat or slightly negatively sloped.
Mouse or other pointing device position	Mouse or other pointing device is positioned close to and directly next to and on the same level as the keyboard.

2. Chair
Component	Adjustment	Yes	No	N/A
Seat height	Seat height is adjusted so feet rest comfortably flat on the floor or footrest, knees are bent at right angles and thighs are horizontal to floor or knees are just slightly lower than the hips. Seat height and keyboard height are coordinated so arms are in the correct position as specified in Item 1 above.
Seat back	Seat back is adjusted so it supports the lumbar curve of the low back. The curve of the back of the chair fits into the lumbar curve of the low back. The back of the chair tilts back slightly if required for comfort.
Seat pan depth	The seat pan depth is adjusted so the front edge of the seat pan is about 2” — 4” from the backs of the knees.
Seat pan tilt	The seat pan tilt is adjusted so hips and tops of thighs are at right angles or slightly greater.
Armrest position	The armrests are adjusted so that they are out of the way while typing, but may provide support during other activities (i.e. phone use, meetings, etc). With shoulders relaxed, the armrests are slightly below elbows, and arms hang comfortably at sides.
Chair position	Chair can get close enough to keying, mousing, or writing surfaces without reaching.

3. Monitor
Component	Adjustment	Yes	No	N/A
Monitor height	The monitor height is adjusted so the top 1/3 of the screen is at or slightly lower than eye level, the top line of print is at or just below eye level or even lower if wearing bifocal, trifocal, or progressive lenses. Employee is able to scan the screen from top to bottom using only eye movements, not head movements.
Screen-to-employee distance	Viewing distance is approximately arms distance away (16”— 28”). Employee can sit against the back of the chair and read the monitor screen from a comfortable distance, without experiencing eye fatigue, blurred vision, or headaches.
Monitor alignment with employee	Monitor is placed directly behind the keyboard in front of employee.
Visual comfort of screen	Monitor is positioned to avoid glare. Workstation is positioned so monitor is perpendicular to window or other strong light source and ceiling lights are off to the side of the monitor instead of in front, behind, or directly overhead.

4. Work Environment and Work Surface
Component	Adjustment	Yes	No	N/A
Leg clearance at workstation	The width below the desk allows for 2” + hip width, the height below the desk allows for the highest point of thighs or higher, and the depth allows for proper sitting position while giving foot/knee clearance.
Placement of frequently used items and equipment	Frequently used items and equipment (i.e., phone) on the work surface are close at hand and can be accessed and used without overreaching or using awkward postures.
Looking at document while typing	The document is off the flat work surface and at the same distance as the monitor screen.
General task lighting	Lighting is not direct or overly bright.

5. Work Practices
Component	Adjustment	Yes	No	N/A
Frequency of micro breaks	Employee takes a micro break every 10-20 minutes and changes postures frequently.
Keyboarding posture	Wrists are straight and not rested on any surface while typing.
Sitting posture	Employee sits upright or with a slightly reclined posture and maintains a slight hollow in lower back.
Telephone use posture	Employee does not tilt head /neck to cradle the telephone and uses hand to hold receiver or wears headset.
Alternate tasks	While performing long periods of continuous computer use, employee performs small tasks /errands to prevent sitting in the same position for extended periods of time.
Task training	Employees are trained on the software programs and operating systems they are using.

Environmental Health and Safety

Computer Workstation Ergonomic Self-evaluation Survey