OFFICE ERGONOMICS - BASIC SELF-EVALUATION CHECKLIST Name: _______________________________________________ Chair Yes Date:_________________________________ No Are you able to sit without feeling pressure from the chair seat on the back of your knees? Does your chair provide support for your lower back? Do your armrests allow you to get close to your workstation? Keyboard and Mouse Yes No Are frequently used objects within easy reach? When using your keyboard and mouse, are your wrists straight and your upper arms relaxed by your side? Is your mouse at the same level and as close as possible to your keyboard? Do you alternate the hand used for controlling the mouse? Yes No o o o Is your monitor height slightly below eye level? o o o o o o o Breaks Yes No Accessories Is your copy (document) holder positioned directly in front of you? Are you using a headset or speakerphone if you are writing or keying while on the phone? Yes No Reposition monitor Reposition monitor Obtain flat screen or deeper work surface is there is not enough space Add or remove monitor stand Adjust monitor height Windows as 90 degrees to monitor Adjust overhead lighting Cover windows Tilt screen downward Obtain anti-glare screen N/A (if no, suggested corrective actions) o o Do you take stretch breaks at least every 30 minutes? Do you take regular eye breaks from looking at your monitor? Raise or lower workstation Raise or lower keyboard Raise or lower chair Rearrange workstation Recheck chair, raise or lower as needed Check posture Check keyboard and mouse height Move mouse closer to keyboard Obtain larger keyboard tray if necessary Switch hands and adjust buttons in Control Panel N/A (if no, suggested corrective actions) Is your monitor positioned directly in front of you? Is your monitor positioned at least an arm’s length away? Is your monitor and work surface free from glare? Obtain a properly functioning chair Lower the chair Add footrest Re-adjust for footwear height Adjust seat pan depth Add a back support Adjust chair back Obtain proper chair Obtain lumbar support/roll Adjust armrests Remove armrests N/A (if no, suggested corrective actions) o o o o o o o o o o Are your keyboard, mouse and work surface at your elbow height? Work Surface N/A (if no, suggested corrective actions) o o o o o o o o o o o Can the height, seat and back of your chair be adjusted? Are your feet fully supported by the floor when you are seated? Set reminders to take breaks Refocus on an object at least 10’ away every few minutes N/A (if no, suggested corrective actions) o o o Obtain a different document holder Adjust workstation set-up Obtain a headset if using the phone This material is provided to you for general informational purposes only. Maintaining safe operations and a safe facility in accordance with all laws is your responsibility. We make no representation or warranty, express or implied, that our activities or advice will place you in compliance with the law; that your premises or operations are safe; or that the information provided is complete, free from errors or timely. We are not liable for any direct, indirect, special, incidental or consequential damages resulting from the use or misuse of this information. You are not entitled to rely upon this information or any loss control activities provided by us, and you may not delegate any of your legal responsibilities to us. © 2013-2016 Berkley Technology Underwriters. All rights reserved.