Questionnaire

-By The Department of Industrial Engineering, RV College of Engineering, Bangalore This questionnaire is designed assess the efficacy of existing ergonomic reforms in computer workstation and visual display terminal (VTD) layout and design. Employee Name: _____________________ Age:______ Company:_____________________ Division\Bureau: _______________________ Employees Position Title: ___________________________ Time in Position: _________ Ergonomic Coordinator: _____________________________________________________ Part 1: Work Activity 1. Which shift do you cover? Specify the approximate duration of your shift. a) Day Shift __________ b) Night Shift _________ 2. How much time do you spend on the computer on an average workday? a) 0 to 2 hours b) 2 to 4 hours c) 4 to 6 hours d) 6 to 8 hours

3. What are the tasks performed on the computer? Tick more than one option, if applicable a) Spreadsheets b) Documentation c) Data Analysis d) Other(s):_________________ 4. How much time do you spend at your desk doing other non-computer activities during an average workday? a) 0 to 2 hours b) 2 to 4 hours c) 4 to 6 hours d) 6 to 8 hours 5. How repetitive are your tasks? a) High (as in data entry) b) Moderate (as in computer drafting) c) Low 6. How much time do you spend on the phone during an average workday? a) 0 to 2 hours b) 2 to 4 hours c) 4 to 6 hours d) 6 to 8 hours 7. Are your rest periods adequate to relieve stresses? Specify approximate duration. a) Yes._______ b) No._______ 8. Do you have any of the following conditions? Answer the following with Yes(Y) or No (N). a) Vision Impairment:____ b) Respiratory/Heart Conditions:____ c) Physical Disability:____ d) Other(s):_____

9. Have you ever consulted a physiotherapist for treating Cumulative Trauma Disorders (CTDs) or bodily stresses? a) Yes b) No

Part 2: Check the area(s) of discomfort and number which best describes associated discomfort. (1= slight discomfort, 3=moderate, 5=significant pain)

Area of Body Eyes Fingers, thumbs Hand, wrist Forearm, elbow Upper arm, Shoulder Thigh, knee Lower leg Foot, ankle Neck Upper middle back Lower back Other(s): 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 1 1 1 1

Right 3 3 3 3 3 3 3 3 2 2 2 2 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 3 3 3 3 1 1 1 1 1 1 1 1 4 4 4 4

Left 2 3 2 3 2 3 2 3 2 3 2 3 2 3 2 3 5 5 5 5 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5

Part 3: List of Current Ergonomic Tools/Furniture: Answer with Yes(Y) or No (N). 1. Adjustable Headrests:___ 2. Adjustable Armrests:___ 3. Desk:__ (Mention type, if Yes)_________________ 4. Soft Keyboard:___ 5. Mouse Wrist rests: ___ 6. Adjustable Keyboard and Mouse tray: ___ 7. Monitor Risers: ___

8. Footrest: ____ 9. Headset: ________ 10. Adjustable Lighting:________ 11. Adjustable Ventilation:________ Other(s) (Please specify, if Yes) __________________________________________________

Thank You