EXAMPLE 3 - VA Hospital - Office Ergonomic Report.pdf

Remote Home Office Ergonomic Evaluation Report Report Date: 1/5/2024

Background Information:

Name Evaluation Date

Address Employer

City/State Zip Job Title

Employee Email Supervisor

Employee Phone Supervisor Email

Reason for Referral:

The client requested this consultation to address her concerns of pain associated with working at a multiuser computer workstation at a service counter. She works 3 hours of her shift entirely in a standing position and has the endurance to do so without pain or fatigue in her lower extremities.

Work Tasks (hr/day):

The below refers to the service counter workstation shown in the picture.

Total Work Hrs. 3 Total Computer Hrs. 3 Hours on Phone <1

Keyboard 50% Mouse 50% Numeric Keypad Frequently

Handwriting <1 Meeting <4 Reference Papers Occasionally

Non-Computer <1 Sitting at work <8 Breaks As Needed

Primary Job Tasks:

She is primarily working at a computer and talks to people through the service counter.

Job images

Ergonomic Analysis/Findings & Recommendations

The following information was gained through a telephonic interview of the job tasks and working environment. Job tasks were reviewed and observed through digital pictures to determine any risk factors as they relate to employee discomfort.

Ergonomic Report: 2

The recommendations below are provided as suggestions to minimize exacerbation of symptoms and/or reduce risk of injury to the employee.

Ergonomic Findings Ergonomic Recommendations

Current chair not adjusted. Made the following adjusted with the employee providing instruction and training on how and why the adjustments were necessary:

Seat height lowered, seat tilt placed/locked in a more reclined position, and seat back raised to match inward curve of lower back.

Desk high encouraging contact pressure on the forearms and shoulder flexion.

Lowered the seated desk height to discourage contact pressure on the forearms and shoulder flexion.

Recommended Equipment

Vendor Item Description

- None -

Ergonomic Report: 3

Employee Discomfort

Discomfort level from 1-10 prior to ergonomics evaluation: 10/10 Pain Scale Reported

Height: 65 Dominate Hand ☒ R ☐ L

☒ Constant Discomfort ☐ Intermittent Discomfort

Body Parts Affected Description

Neck

Postures

Wrist: Ok Head/Neck: Ok Vision: Ok

Elbow: Ok Shoulders: Flexion

Back: Ok Forearm: Resting on sharp surface

Is the top of your monitor at eye level, or if using graduated lenses, is the screen placed lower? Yes ☒ No ☐

Is the screen at least an arm’s length from your eyes? Yes ☒ No ☐

Is your keyboard & mouse at the same height as your elbows when relaxed at your sides? Yes ☐ No ☒

Do your wrists remain flat/straight when typing? Yes ☒ No ☐

Are your shoulders relaxed when computing? Are upper arms roughly parallel with your torso? Yes ☐ No ☒

When seated, are your feet flat on the floor or footrest with your hips at a 90–120° angle? Yes ☒ No ☐

Does the chair move easily and function properly? Yes ☒ No ☐

Do you know how to adjust your chair? Yes ☒ No ☐

Do you take your breaks? Yes ☒ No ☐

Workstation Design

Desk:

Type: Free Standing Shape: Straight

Corners: 90 Degree Corners Edges: Sharp/Square

Chair:

Chair Type: Task Chair Chair Brand/Name: Humanscale Freedom

Chair Adjustability Height Depth Width Tilt

Seat Pan Yes ☒ No ☐ Yes ☐ No ☒ Yes ☐ No ☒

Backrest Yes ☒ No ☐ Yes ☐ No ☒ Yes ☐ No ☒

Lumbar Adjustment Yes ☒ No ☐ Yes ☐ No ☒

Armrest Yes ☒ No ☐ Yes ☐ No ☒ Yes ☐ No ☒

Ergonomic Report: 4

Equipment:

Monitor: Dual Orientation: Center Location: Desktop

Keyboard: Standard Orientation: Center Location: Desktop

Mouse: Standard Orientation: Right Location: Desktop

Phone: Orientation: Location:

Wrist Rest: Material: Location:

Other Items:

If there are any questions or clarifications that you find necessary with regard to this report, please do not hesitate to contact me directly at the address and phone number indicated below.