Professional Documents
Culture Documents
Evaluator: Date:
Insufficient Space
Under Desk - Ability Non-Adjustable
YE (+1)
Knees at 90° Too low- Knee Too High - No foot
to Cross Legs (+1)
NO NO 0
(1) Angle < 90° Knee Angle contact on S YES
(2) > 90° (2) ground (3) (0) (0)
(+ (+1)
Section A
Seat Pan Depth 1) Additional Considerations + Score A & B Score Duration Chair Score
N
YE
O
S YES YES
Elbows Supported in Too Low (Arms Too High Too Wide (+1) NO NO
Hard/Damaged 0
line with shoulders, Unsupported) (2) (Shoulders (+ (+1)
Non- Adjustable (+1)
(+1)
surface (+1)
shoulders relaxed (1) Shrugged) (2) ( (0) (0)
1)
Section B
0
NOTES:
Back Support ) Additional Considerations + Score
YES
YES NO ROSA
Adequate Lumbar
Support- Chair No Lumbar Support OR
reclined between 95°Lumbar Support
Angled Too Far
Not in Small Back (Greater
Angled Too Far
Forward (Less
No Back Support (ie
Stool OR Worker
Work Surface Too High,
NO
Shoulders Shrugged
Back Rest Non-
Adjustable (+1) 0 Grand Score
and 110° (1) of Back (2) than 110°) (2) than 95°) (2) Leaning Forward) (2) (+1)(+1) (+1
(0)
)(0)
Monitor Additional Considerations Score Duration
Duration:
+1 if ≥ 1 hr/day consecutively or ≥ 4 hrs/day intermittently
0 if 30 min - 1 hr/day consecutively or 1-4 hrs/day intermittently
YES YES YES YES
NO
Arm's Length Distance Too Low (below Too High (3) Too Far (+1)
NO
Glare on
NO (+1)
(+1)
Screen
Neck Twist Greater
NO
(+1)
Documents - No
(+1)
Holder (+1) 0 -1 if < 30 min/day consecutively or < 1 hr/day intermittently
(40-75cm) / Screen at
Eye Level (1)
30°) (2)
(+1) than 30° (+1)
(0) (0) (0)
(0)
Section C
No Hands-Free Option
YES (+1)YES 0
Headset / One Hand on Too Far of Reach NO
Neck and Shoulder NO
Phone & Neutral Neck
Posture (1)
(outside of 30 cm) (2) (+2)
Hold (+2) (+1)
(0) (0)
Peripherals Score
Mouse Additional Considerations Score Duration
YE
N
YES YES S 0
Mouse in line with Reaching To NO
Mouse/Keyboard on
NOGrip on Mouse (+1) O
Palmrest in Front of
Shoulder (1) Mouse (2) (+2)
Different Surfaces (+2) (+1)
Pinch (+
Mouse (+1)
(0) (0) (0
1)
)
Section D
Data Table I: Section A & B Score Section A: Chair Height & Seat Pan Depth
2 3 4 5 6 7 8 9
Arm Rest & Back
2 2 2 3 4 5 6 7 8
3 2 2 3 4 5 6 7 8
Section B:
Support
4 3 3 3 4 5 6 7 8
5 4 4 4 4 5 6 7 8
6 5 5 5 5 6 7 8 9
7 6 6 6 7 7 8 8 9
8 7 7 7 8 8 9 9 9
0 1 1 1 2 3 4 5 6
1 1 1 2 2 3 4 5 6
2 1 2 2 3 3 4 6 7
3 2 2 3 3 4 5 6 8
4 3 3 4 4 5 6 7 8
5 4 4 5 5 6 7 8 9
6 5 5 6 7 8 8 9 9
0 1 1 1 2 3 4 5 6
1 1 1 2 3 4 5 6 7
2 1 2 2 3 4 5 6 7
3 2 3 3 3 5 6 7 8
4 3 4 4 5 5 6 7 8
5 4 5 5 6 6 7 8 9
6 5 6 6 7 7 8 8 9
7 6 7 7 8 8 9 9 9
2 2 2 3 4 5 6 7 8 9
3 3 3 3 4 5 6 7 8 9
Telephone
4 4 4 4 4 5 6 7 8 9
5 5 5 5 5 5 6 7 8 9
6 6 6 6 6 6 6 7 8 9
7 7 7 7 7 7 7 7 8 9
8 8 8 8 8 8 8 8 8 9
9 9 9 9 9 9 9 9 9 9
5 5 5 5 5 5 6 7 8 9 10
6 6 6 6 6 6 6 7 8 9 10
7 7 7 7 7 7 7 7 8 9 10
8 8 8 8 8 8 8 8 8 9 10
9 9 9 9 9 9 9 9 9 9 10
10 10 10 10 10 10 10 10 10 10 10
Data Table VI
Score = 1-5: Further assessment not immediately
Grand required.
Score
Grand Score > 5: The office workstation requires further
Score assessment; changes should be considered
immediately.