OFFICE ERGONOMICS SET-UP CHECKLIST

AND DISCOMFORT SURVEY

Staff Name Date

Department Completed by

CHAIR Yes No N/A If No, Suggested Actions

Can the height, seat pan and back of  Obtain a properly functioning chair
your chair be adjusted?
Are your feet fully supported by the floor  Lower the chair
when you are seated?  Use footrest
 Re-adjust for footwear height
Are you able to sit without feeling  Adjust seat pan
pressure from the chair seat on the back  Add a back support
of your knees?
Does your chair provide support for your  Adjust chair back
lower back?  Obtain proper chair
 Obtain lumbar roll
Do your armrests allow you to get close  Adjust armrests
to your workstation?  Remove armrests
KEYBOARD & MOUSE Yes No N/A If No, Suggested Actions
Are your keyboard, mouse and work  Reposition monitor
surface at your elbow height?
Is your monitor positioned at least an  Reposition monitor
arm’s length away?  Obtain flat screen or deeper work
surface if there is not enough space
Is your monitor height slightly below eye  Add or remove monitor stand
level?  Adjust monitor height
Are your monitor and work surface free  Windows at side of monitor
from glare?  Adjust overhead lighting
 Cover windows
 Tilt screen downward
 Obtain anti-glare screen
Do you have a desk lamp for reading or  Obtain desk lamp
writing documents?  Place on left if right-handed, place on
right if left-handed
WORKSURFACE Yes No N/A If No, Suggested Actions
Is your monitor positioned directly in  Reposition monitor
front of you?
Is your monitor positioned at least an  Reposition monitor
arm’s length away?  Obtain flat screen or deeper work
surface if there is not enough space
Is your monitor height slightly below eye  Add or remove monitor stand
level?  Adjust monitor height
Are your monitor and work surface free  Windows at side of monitor
from glare?  Adjust overhead lighting
 Cover windows

Do you have a desk lamp for reading or
writing documents?
BREAKS
Do you take stretch breaks every 30
minutes?
Do you take regular eye breaks from
looking at your monitor?
ACCESSORIES
Is your document ramp positioned
directly in front of you?
Are you using a headset or speakerphone
if you are writing or keying while talking
on the phone?
 Tilt screen downward
 Obtain anti-glare screen
 Obtain a desk lamp
 Place on left if right-handed, place on
right if left-handed
Yes No N/A If No, Suggested Actions
 Set reminders to take breaks
 Re-focus on a picture on the wall or
plants every few minutes
Yes No N/A If No, Suggested Actions
 Obtain a different document ramp
 Adjust workstation set-up
 Obtain a headset if using a phone

PHYSICAL DISCOMFORT SCALE TASKS THAT USUALLY CAUSES

BODY PART 0=no discomfort; 10=worst imaginable discomfort DISCOMFORT
Neck 0 1 2 3 4 5 6 7 8 9 10

Left Shoulder 0 1 2 3 4 5 6 7 8 9 10

Right Shoulder 0 1 2 3 4 5 6 7 8 9 10

Left Elbow 0 1 2 3 4 5 6 7 8 9 10

Right Elbow 0 1 2 3 4 5 6 7 8 9 10

Left Wrist/Hand 0 1 2 3 4 5 6 7 8 9 10

Right Wrist/Hand 0 1 2 3 4 5 6 7 8 9 10

Back 0 1 2 3 4 5 6 7 8 9 10

Left Knee 0 1 2 3 4 5 6 7 8 9 10

Right Knee 0 1 2 3 4 5 6 7 8 9 10

Legs 0 1 2 3 4 5 6 7 8 9 10

Which body part rated above

represents the one in which you
feel the most discomfort?
Have you sought or received
medical assistance or treatment
(chiropractor, physiotherapy,
family doctor, etc.) or other for
this specific body part?
If Yes, please specify.
Have there been any changes
made to your job, workstation or
activities that you must perform
to do your work?
If Yes, please specify.
What do you think could improve
your job?