Username or Email Address Password Remember Me Log In Lost your password? | Register Continue with Google Office Ergonomics EN (#16) Company CodePersonal DataPosture and MovementChair Setup and ComfortDesk and Work Surface SetupMonitor and Screen SetupKeyboard, Mouse, and Input DevicesWork Habits and BreaksDiscomfort and Pain EvaluationWork Environment (Noise, Lighting, Temperature)Dry eye assessment CodePlease be advised that the data will solely be utilized for the enhancement of your work conditions. It will not be disseminated to any external entities, and will exclusively be shared with your medical organization for the purpose of formulating an appropriate action plan. By consenting to this agreement, you acknowledge and agree to all terms and conditions outlined hereinPreviousNextFull NameEmployee Corporate IDDepartmentAgeHeightWeightContact Email Number of Years with the CompanyCommute Duration Less than 30 min From 30 min to 1 hr From 1 hr to 2 hr More than 2 hr Other Primary Mode of Commuting to Work By using transportation Driving car Walking OtherWork Shift Pattern Morning shift only Evening Night shifts OtherAverage Daily Computer UsageType of Computer Equipment Used Single Screen Desktop Laptop Double Screen Desktop OtherDo you use any visual aids? Yes NoDo you use any other visual aids ? Eye Glasses Contact Lenses Others How many days do you usually work from home ? 1-2 days 2-3 days 3-4 days Not applicable PreviousNextAre your feet fully supported by the floor or a footrest while sitting ? Yes NoCommentNumeric Score Are your feet fully supported by the floor or a footrest while sitting ?Textarea Message Are your feet fully supported by the floor or a footrest while sitting ?Use a footrest or adjust your chair height to ensure your feet are flat on the floor for support__________________________________Are your knees at a 90-degree angle with hips, while sitting? Yes NoCommentNumeric Score Are your knees at a 90-degree angle with hips, while sitting?Textarea Message Are your knees at a 90-degree angle with hips, while sitting?Adjust your chair height or use a footrest to achieve a 90-degree angle at your knees__________________________________Are your hips positioned slightly above your knees for improved circulation? Yes NoComment Numeric Score Are your hips positioned slightly above your knees for improved circulation?Textarea Message Are your hips positioned slightly above your knees for improved circulation?Raise your chair height or adjust the seat to ensure hips are slightly above knees__________________________________Does your chair provide lumbar support in the curve of your lower back, and does the backrest fully support your back without requiring you to lean forward? Yes NoComment Numeric Score Does your chair provide lumbar support in the curve of your lower back, and does the backrest fully support your back without requiring you to lean forward?Textarea Message Does your chair provide lumbar support in the curve of your lower back, and does the backrest fully support your back without requiring you to lean forward?Consider using a lumbar support cushion or adjusting your chair for better back support__________________________________Are your shoulders relaxed and not raised while typing, with your elbows close to your body forming a 90-120 degree angle? Yes NoComment Numeric Score Are your shoulders relaxed and not raised while typing, with your elbows close to your body forming a 90-120 degree angle?Textarea Message Are your shoulders relaxed and not raised while typing, with your elbows close to your body forming a 90-120 degree angle?Adjust your chair and keyboard height to keep elbows at 90-120 degrees, allowing shoulders to relax__________________________________Are your wrists straight when typing or using the mouse, with no bending upward or downward? Yes NoComment Numeric Score Are your wrists straight when typing or using the mouse, with no bending upward or downward?Textarea Message Are your wrists straight when typing or using the mouse, with no bending upward or downward?Position your keyboard and mouse so wrists remain neutral. Use wrist supports if necessary__________________________________Do you regularly change positions or stand every 60-90 minutes to prevent prolonged sitting? Yes NoComment Numeric Score Do you regularly change positions or stand every 60-90 minutes to prevent prolonged sitting?Textarea Message Do you regularly change positions or stand every 60-90 minutes to prevent prolonged sitting?Set reminders to stand, stretch, or change positions regularly to avoid prolonged sitting__________________________________Are you able to maintain a neutral head position without bending or tilting? Yes NoComment Numeric Score Are you able to maintain a neutral head position without bending or tilting?Textarea Message Are you able to maintain a neutral head position without bending or tilting?Try to keep your head in a straight position as much as possiblePreviousNextIs your chair adjustable in height, backrest, and seat depth? Yes NoComment Numeric Score Is your chair adjustable in height, backrest, and seat depth?Textarea Message Is your chair adjustable in height, backrest, and seat depth?Try to use some accessories that may help you maintain your body in the correct position__________________________________Are you sitting back fully in the chair, using the entire backrest for support, with 2-4 cm of space between the front edge of your seat and the back of your knees? Yes NoComment Numeric Score Are you sitting back fully in the chair, using the entire backrest for support, with 2-4 cm of space between the front edge of your seat and the back of your knees?Textarea Message Are you sitting back fully in the chair, using the entire backrest for support, with 2-4 cm of space between the front edge of your seat and the back of your knees?Ensure you sit back fully against the backrest and adjust the chair as needed for support__________________________________Is the seat pan of your chair the appropriate size for your body (not too wide or too narrow)? Yes NoComment Numeric Score Is the seat pan of your chair the appropriate size for your body (not too wide or too narrow)?Textarea Message Is the seat pan of your chair the appropriate size for your body (not too wide or too narrow)?Consider a chair with a seat pan that fits your body size for better comfortPreviousNextIs there sufficient clearance under your desk for leg movement? Yes NoComment Numeric Score Is there sufficient clearance under your desk for leg movement?Textarea Message Is there sufficient clearance under your desk for leg movement?Ensure your desk is free from obstruction to allow for comfortable leg movement__________________________________Do you have enough surface space for your keyboard, mouse, and other items? Yes NoComment Numeric Score Do you have enough surface space for your keyboard, mouse, and other items?Textarea Message Do you have enough surface space for your keyboard, mouse, and other items?Organize your workspace to ensure you have sufficient surface space for all necessary items__________________________________Is your desk surface free of clutter that impedes free hand and arm movement? Yes NoComment Numeric Score Is your desk surface free of clutter that impedes free hand and arm movement?Textarea Message Is your desk surface free of clutter that impedes free hand and arm movement?Regularly declutter your desk to promote easier access and movement__________________________________Are frequently used objects within easy reach to avoid overreaching? Yes NoComment Numeric Score Are frequently used objects within easy reach to avoid overreaching?Textarea Message Are frequently used objects within easy reach to avoid overreaching?Rearrange your workspace so that frequently used items are easily accessiblePreviousNextIs your monitor centered and directly in front of you, with the top of the screen at or slightly below eye level to avoid neck strain? Yes NoComment Numeric Score Is your monitor centered and directly in front of you, with the top of the screen at or slightly below eye level to avoid neck strain?Textarea Message Is your monitor centered and directly in front of you, with the top of the screen at or slightly below eye level to avoid neck strain?Adjust your monitor so it's centered and directly in front of you at eye level__________________________________Is your monitor at an arm’s length distance from your eyes (about 20-30 inches) ? Yes NoComment Numeric Score Is your monitor at an arm’s length distance from your eyes (about 20-30 inches) ?Textarea Message Is your monitor at an arm’s length distance from your eyes (about 20-30 inches) ?Move your monitor to maintain a distance of 50-70 cm to reduce eye strain__________________________________Does your monitor have anti-glare properties or a filter to reduce eye strain? Yes NoComment Numeric Score Does your monitor have anti-glare properties or a filter to reduce eye strain?Textarea Message Does your monitor have anti-glare properties or a filter to reduce eye strain?Use an anti-glare screen filter or adjust the monitor angle to minimize glare__________________________________Do you follow the 20-20-20 rule (looking at something 20 feet away for 20 seconds every 20 minutes)? Yes NoComment Numeric Score Do you follow the 20-20-20 rule (looking at something 20 feet away for 20 seconds every 20 minutes)?Textarea Message Do you follow the 20-20-20 rule (looking at something 20 feet away for 20 seconds every 20 minutes)?Set reminders to practice the 20-20-20 rule: look at something 20 feet away for 20 seconds every 20 minutesPreviousNextIs your keyboard positioned directly in front of you and aligned with your monitor, with your wrists in a neutral position while typing, avoiding any extension or flexion? Yes NoComment Numeric Score Is your keyboard positioned directly in front of you and aligned with your monitor, with your wrists in a neutral position while typing, avoiding any extension or flexion?Textarea Message Is your keyboard positioned directly in front of you and aligned with your monitor, with your wrists in a neutral position while typing, avoiding any extension or flexion?Position your keyboard directly in front of your body to maintain a neutral wrist position__________________________________Is your mouse positioned close to the keyboard for easy reach without stretching, and are you able to alternate between keyboard shortcuts and mouse usage to reduce strain? Yes NoComment Numeric Score Is your mouse positioned close to the keyboard for easy reach without stretching, and are you able to alternate between keyboard shortcuts and mouse usage to reduce strain?Textarea Message Is your mouse positioned close to the keyboard for easy reach without stretching, and are you able to alternate between keyboard shortcuts and mouse usage to reduce strain?Place your mouse close to the keyboard to prevent stretching and promote ease of usePreviousNextDo you perform stretching exercises during breaks to relieve tension? Yes NoComment Numeric Score Do you perform stretching exercises during breaks to relieve tension?Textarea Message Do you perform stretching exercises during breaks to relieve tension?Incorporate stretching exercises into your breaks to relieve tension and improve circulation__________________________________Are you trained on how to maintain a good posture throughout the day? Yes NoComment Numeric Score Are you trained on how to maintain a good posture throughout the day?Textarea Message Are you trained on how to maintain a good posture throughout the day?Attend training on ergonomic principles to improve posture awarenessPreviousNextDo you currently experience any pain ? Yes NoTextarea Message Do you currently experience any pain ?Consult a healthcare professional for assessment and tailored recommendationsRefer to specific areas where you may experience pain. Note : you can choose more than one area Refer to specific areas where you may experience pain. Then, indicate the degree of pain you feel in each identified area 1- Head front / side 2- Neck front 3- Shoulder front 4- Chest 5- Arm / elbow outer 6- Arm / elbow inner 7- Abdominal 8- Groin 9- Hand wrist 10- Hip front 11- Thigh outer 12- Thigh inner 13- Knee front 14- Shin / ankle outer 15- Shin / ankle inner 16- Foot front 17- Head back / side 18- Neck back 19- Shoulder back 20- Upper back 21- Arm / elbow outer 22- Arm / elbow inner 23- Lower back 24- Buttock / hip back 25- Hand wrist 26- Thigh outer / back 27- Thigh inner / back 28- Knee back 29- Calf/ ankle outer 30- Calf/ ankle inner 31- Foot / heelNumeric Score - Refer to specific areas __________________________________Have you ever been diagnosed with a musculoskeletal disorder (MSD)? (e.g., carpal tunnel, tendinitis) Yes NoPlease explain Numeric Score Have you ever been diagnosed with a musculoskeletal disorder (MSD)? (e.g., carpal tunnel, tendinitis)__________________________________Have your musculoskeletal symptoms affected your ability to perform your job Yes NoComment Numeric Score Have your musculoskeletal symptoms affected your ability to perform your job__________________________________Can you confirm if the pain consistently occurs While using your desk ? Yes NoComment Numeric Score Can you confirm if the pain consistently occurs after using your desk ?__________________________________What is your recommendation for improving the workplace to decrease your pain PreviousNextPlease rate your satisfaction with the following elements control management in your workplace :Lighting Bad Good Excellent Please explain why and how it is affecting you Numeric Score Lighting-BadNumeric Score Lighting-GoodNumeric Score Lighting-ExcellentNoise levels Bad Good Excellent Please explain why and how it is affecting you Numeric Score Noise levels-BadNumeric Score Noise levels-GoodNumeric Score Noise levels-Excellent Temperature Bad Good Excellent Please explain why and how it is affecting you Numeric Score Temperature-BadNumeric Score Temperature-GoodNumeric Score Temperature-Excellent Air Quality Bad Good Excellent Please explain why and how it is affecting you Numeric Score Air Quality-BadNumeric Score Air Quality-GoodNumeric Score Air Quality-Excellent Layout of equipment such as desks and Chairs Bad Good Excellent If Bad Please explain why and how it is affecting you Numeric Score Layout of equipment such as desks and Chairs-BadNumeric Score Layout of equipment such as desks and Chairs-GoodNumeric Score Layout of equipment such as desks and Chairs-Excellent Workload Bad Good Excellent If Bad Please explain why and how it is affecting you Numeric Score Workload-badNumeric Score Workload-GoodNumeric Score Workload-Excellent Pace of work Bad Good Excellent Please explain why and how it is affecting you Numeric Score Pace of work-BadNumeric Score Pace of work-GoodNumeric Score Pace of work-Excellent Stress levels Bad Good Excellent Please explain why and how it is affecting you Numeric Score Stress levels-BadNumeric Score Stress levels - GoodNumeric Score Stress levels-Excellent PreviousNextHave you experienced any of the following symptoms now or at any time during the past year ?Textarea Message Have you experienced any of the following symptoms now or at any time during the past year ?Follow up with an eye care professional for evaluation and management of dry eye symptomsAre your eyes sensitive to light ? Yes NoComment Numeric Score Are your eyes sensitive to light ?Do you feel a gritty sensation or roughness in your eyes? Yes NoComment Numeric Score Do you feel a gritty sensation or roughness in your eyes?Do you feel pain or inflammation in your eyes? Yes NoComment Numeric Score Do you feel pain or inflammation in your eyes?Do you experience blurred vision? Yes NoComment Numeric Score Do you experience blurred vision?Have you suffered from hazy vision? Yes NoComment Numeric Score Have you suffered from hazy vision?Have you experienced a reduction in your visual acuity? Yes NoComment Numeric Score Have you experienced a reduction in your visual acuity?Have your eye problems limited your ability to do any of the following over the past year ?Reading Yes NoNumeric Score ReadingDriving at night Yes NoNumeric Score Driving at nightWorking in front of electronic devices and screens Yes NoNumeric Score Working in front of electronic devices and screensWatching TV Yes NoNumeric Score Watching TVHave you felt eye discomfort in any of the following situations in the past year ?In windy conditions Yes NoNumeric Score In windy conditionsIn low-humidity environments Yes NoNumeric Score In low-humidity environmentsIn air-conditioned places Yes NoNumeric Score In air-conditioned placesAny final comment or recommendationCommentNumeric - Final ScoreTextarea Score - Low RiskLow Risk Textarea Score - Medium RiskMedium RiskTextarea Score - High RiskHigh Risk Previous Send
