whs_frm_023 Workstation Ergonomic Self-Assessment

WORKSTATION ERGONOMIC SELF-ASSESSMENT

Name Dwi Prio Utomo Date July 15, 2021

The Workstation Ergonomics Self-Assessment is best undertaken by two people, e.g. with your supervisor or
safety representative. This enables the person to sit at their workstation while a second person observes and
assists them achieve the recommended posture.

Ite N/
Office Chair Yes No Suggested Actions
m A
1 Can the height, seat and back of the chair  Obtain a fully adjustable chair
be adjusted to achieve the posture outlined
below?
2 Are feet fully supported by the floor when  Lower the chair
seated?
 Use a footrest
3 Does the chair provide support for user’s  Adjust chair back
lower back?
 Obtain proper chair
 Obtain lumbar roll
4 When user’s back is supported, they can sit  Adjust seat pan
without feeling pressure from the chair seat
 Add a back support
on the back of knees?
5 Do armrests allow user to get close to  Adjust armrests
workstation?
 Remove armrests

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whs_frm_023 Workstation Ergonomic Self-Assessment

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 whs_frm_023 Workstation Ergonomic Self-Assessment

Item Keyboard and Mouse Yes No N/A Suggested Actions

6 Is the keyboard, mouse and work  Raise / lower workstation
surface at elbow height?
 Raise or lower keyboard
 Raise or lower chair
7 Are frequently used items within easy  Rearrange workstation
reach?
8 Is the keyboard close to the front edge  Move keyboard to correct
of the desk allowing space for the wrist position
to rest on the desk surface?
9 When using keyboard and mouse, are  Re-check chair, raise or lower as
wrists straight and upper arms relaxed? needed
The keyboard should be flat and not  Check posture
propped up on keyboard legs as an
 Check keyboard and mouse
angled keyboard may place the wrist in
height
an awkward posture when keying.
10 Is mouse at the same level and as close  Move mouse closer to keyboard
as possible to keyboard?
 Obtain larger keyboard tray if
necessary
11 Is the mouse comfortable to use?  Rest dominant hand and use
mouse with non-dominant hand
for brief periods
 Investigate alternate mouse
options

Item Work Surface Yes No N/A Suggested Actions

12 Is monitor positioned directly in front of  Reposition monitor
user?
13 Is monitor positioned at least an arm’s  Reposition monitor
length away?
 Seek an alternative monitor if
The monitor’s location is dependent on necessary, e.g. flat screen that
the size of the monitor, the font, screen uses less space
resolution and the individual user, e.g.
vision/use of glasses.
14 Is monitor height slightly below eye  Add or remove monitor stand
level?
 Adjust monitor height
15 Is monitor and work surface free from  Windows at side of monitor
glare?
 Adjust overhead lighting
 Cover windows
 Obtain antiglare screen
16 Is there appropriate light for reading or  Obtain desk lamp

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Item Work Surface Yes No N/A Suggested Actions
writing documents?  Place on left if right-handed;
place on right if left-handed
17 Are frequently used items located  Rearrange workstation
within the usual work area and items
which are only used occasionally in the
occasional work area?

Ite N/
Breaks Yes No Suggested Actions
m A
18 Is user taking postural breaks every  Set reminders to take breaks
thirty (30) minutes? E.g. standing,
walking to printer / fax etc.?
19 Is user taking regular eye breaks from  Refocus on picture on wall every
looking at monitor? 30 minutes

Ite N/
Accessories Yes No Suggested Actions
m A
20 Is there a sloped desk surface or angle  Obtain an angle board
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 board for reading and writing tasks if
required?
21 Is there a document holder either  Obtain document holder
beside the screen or between the screen
and keyboard if required?
22 Are you using a headset or  Obtain a headset if using the
speakerphone if you are writing or phone and keyboard
keying while talking on the phone?

Ite N/
Laptop Yes No Suggested Actions
m A
23 In the event of using a laptop computer  Obtain appropriate laptop
for prolonged periods of time use of: accessories
 A full-sized external keyboard and
mouse
 Docking station with full sized
monitor or a laptop stand

Ite N/
Hot Desking (when applicable) Yes No Suggested Actions
m A
24 Provided time, support and supervision
to make above adjustments.

Following completion of this checklist, please discuss any concerns or requirements with your supervisor. All
completed assessments should be submitted to HR.

Dwi Prio Utomo July 15, 2021

EMPLOYEE NAME Date

Ignatius Ega Putra July 15, 2021

MANAGER NAME Date

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