Ergonomic office furniture & computer accessories since 1993

CATEGORIES:

You Are Here: Home > Other Ergonomic Products > Ergonomic Assessment Services > Advanced Ergonomic Assessment

Advanced Ergonomic Assessment

An ergonomic assessment of your workstation can help identify stressors at work and
let you know what you need to do to make your workspace more comfortable and more productive. To get started:

Find a ruler or tape measure and a digital camera.
Fill out the questionnaire and upload up to six photos. (Note: All questions and a minimum of two photos are required in order for us to provide the Advanced Ergonomic Assessment.)
Click 'Submit.' You'll be brought to a page where you can pay $249.00 for the assessment.

Within two business days, you will receive a phone call from the doctor, as well as a personalized report addressing your work habits, health issues, and work equipment, with recommendations prioritized by their capacity to improve your comfort and productivity.

About You
1. Name:
2. Email:
3. Occupation:
4. Do you have an ergonomically-related condition? If yes, what is the diagnosis?
5. What do you hope to achieve by completing this questionnaire?

Body Part Comfort Survey

To what degree does pain restrict your activity?

	No Pain	Just noticeable (Does not restrict activity.)	Some Pain (Restricts some activity.)	Moderate Pain (Restricts most activity.)	Intolerable Pain (Restricts all activity.)	Comments If you know what causes the pain, please note this.
6. Eyes
7. Neck
8. Shoulders
9. Upper Back
10. Mid Back
11. Lower Back
12. Buttocks
	No Pain	Just noticeable (Does not restrict activity.)	Some Pain (Restricts some activity.)	Moderate Pain (Restricts most activity.)	Intolerable Pain (Restricts all activity.)	Comments If you know what causes the pain, please note this.
13. Thighs
14. Knees
15. Calves
16. Feet
17. Upper Arms
18. Forearms
19. Wrists
20. Hands

Work Habits
21. Do you usually sit at your workstation, or stand?	Sit Stand
22. How much time usually passes before you take a break?
23. How much time do you spend on the phone each day?
24. Do you use a headset with your telephone?	Yes No
Please indicate the percentage of time you spend on the following activities:	25. % data entry 26. % writing by hand 27. % telephone 28. % other
29. Is your on-site supervisor or team aware of your ergonomic concerns?	Yes No

More About You

Hand Dominance:

30.

31. Can you use your non-dominant hand for mousing?
Yes No

32. On a scale of 1 (light) to 5 (heavy), how hard do you hit the keyboard when typing:

33. How hard do you click the mouse?

Job Training:

34. Did your job training include any training on the adjustment of your chair, keyboard tray (if any) and so on?
Yes No

35. Was it effective?
Yes No

Vision:

36. Tell us about your vision: nearsighted farsighted astigmatic normal

37. Do you wear:
Contacts	Single Lens Glasses
Bifocals / Trifocals	Computer Glasses

Height:

38-39. feet inches

Weight:

40. pounds

Workstation

41. Is your workstation located in a home office?
Yes No

What are the dimensions of the room or cubicle?

42. length: feet

43. width: feet

44. Do you share your workstation?
Yes No

45. Measure the distance from your desk or table-top to the floor. How many inches separate your worksurface from the ground?

inches

Measure the width and depth of the space under your table or desk. Do not include space occupied with supplies.

46. Width: inches

47. Depth: inches

48. What is the shape of your primary worksurface?
If other:

What is the size of your primary worksurface?

49. width: inches

50. depth: inches

51. How cluttered is your primary worksurface?

52. Measure the distance from your torso to your most frequently used office tools (computer, phone, calculators, etc.) Within what range do they fall?

53. Can your monitor and keyboard tray be adjusted for data entry in a standing position, if you normally sit, or a sitting position, if you normally stand?
Yes No

54. At your workstation, do your hands, arms, or legs come into contact with sharp edges?
Yes No

Chair

55. Make and model:

I can adjust:

56. Seat Height	Yes No
57. Seat Angle	Yes No
58. Back Height	Yes No
59. Back Angle	Yes No
60. Arm Height	Yes No
61. Spring Tension	Yes No
62. Arm Width	Yes No
63. Arm Rotation	Yes No
64. Seat Depth	Yes No
65. Lumbar Support	Yes No

66. My feet are flat on the floor.
Yes No

67. My lower legs form an angle to my thighs that is:
less than 90 degrees.
about 90 degrees.
greater than 90 degrees.

68. inches separate the backs of my knees from the front edge of my seat.

69. When I'm seated as far back in my chair as I can go, inches separate my rear from the backrest.

70. The armrests on my chair:
bump into my table/desk.
do not bump into my table/desk.

71. My chair is:
new
somewhat used
old
broken

Keyboard	Mouse
72. Keyboard make and model:	80. Mouse make and model:
73. My keyboard is positioned: at elbow height somewhat above elbow height somewhat below elbow height	81. My mouse is positioned: at elbow height somewhat above elbow height somewhat below elbow height
74. When typing, my forearms and upper arms assume an angle of: about 90 degrees less than 90 degrees greater than 90 degrees	82. When mousing, my forearms and upper arms assume an angle of: about 90 degrees less than 90 degrees greater than 90 degrees
75. My keyboard is: directly in front of me somewhat to the right somewhat to the left	83. My mouse is: directly in front of me somewhat to the right somewhat to the left
76. When typing, my hands are: bent upward at the wrist neutral bent downward at the wrist	84. When mousing, my hands are: bent upward at the wrist neutral bent downward at the wrist
77. My wrists are supported with a wristrest or palm support when typing. Yes No	85. My wrists are supported with a wristrest or palm support when mousing. Yes No
78. My keyboard has: Sharp edges Rounded edges	86. My mouse has: Sharp edges Rounded edges
79. When I'm not using my keyboard, I can push it out of the way I can't push it out of the way	87. When I'm not using my mouse, I can push it out of the way I can't push it out of the way
88. My shoulders feel relaxed while inputting data: Yes No

Computer Monitor

89. At my workstation, I use:
a Cathode Ray Tube (CRT) monitor
a flat panel LCD monitor

90. My monitor is positioned:
directly in front of me
somewhat to the left
somewhat to the right

91. The top of the screen is
at eye level
above eye level
below eye level

92. The monitor is inches from my eyes.

93. Screen size:

94. When I look at the monitor, I see light reflecting off the glass.
True
False

95. The light is coming from:
a window
an overhead light
a lamp on the desk/table
other:

Document Holder

96. The reference materials I need for data entry are supported by:
a document holder
the desk/table
other:

97. The reference materials are positioned:
just below the monitor
somewhat to the right of the monitor
somewhat to the left of monitor.

98. The reference materials are inches from my eyes.

Lighting

99. My workstation is:
well-lit
too bright
too dim
other:

Upload Your Pictures
At a minimum, we need a picture taken from the side, and another from the rear. Ideally, we would like to see six pictures taken from six different angles: from the side from the rear from a point 45° behind the left shoulder from a point 45° behind the right shoulder from overhead, if possible from the front
Picture 1:	Picture 2:	Picture 3:
Picture 4:	Picture 5:	Picture 6:
File Size: 250 KB maximum. File Types: .jpg .jpeg .jpe .gif .bmp .doc .pdf .txt .zip

10,000
Satisfied Customers

Testimonials

Keyboard Trays | Monitor Arms | CPU Holders | Laptop Tables & Stands

Office Chairs | Tables & Desks | AV Carts | Other Products

Customer Service | Contact | About Us | Testimonials

Internet Payment Gateway

ErgoStoreOnline
17319 Meadow Bottom Road
Charlotte, North Carolina 28277
877-971-0151
Fax: 704-543-7655

Top of Page