If you make a mistake or need to change an answer, you can push the "CLEAR" button at the bottom at any time, and start again.

1.     What is your job title?    

2.     What is the name of your manager?   

3.     What does your daily work generally involve? (please give a short description of your typical activities below):

4.     Please indicate the usual amount of time you spend on each of these activities:

• Looking at a screen     (select one) Most of the time Some of the time Only occasionally Never

• Looking down at documents     (select one) Most of the time Some of the time Only occasionally Never

• Operating a keyboard     (select one) Most of the time Some of the time Only occasionally Never

• Holding + using a mouse     (select one) Most of the time Some of the time Only occasionally Never

• Writing     (select one) Most of the time Some of the time Only occasionally Never

• On the phone     (select one) Most of the time Some of the time Only occasionally Never

• Sitting     (select one) Most of the time Some of the time Only occasionally Never

• Meetings in the office     (select one) Most of the time Some of the time Only occasionally Never

• Working away from the office     (select one) Most of the time Some of the time Only occasionally Never

• Any other significant activities?     (select one) Most of the time Some of the time Only occasionally Never - please enter details below:

5.     Do you have enough desk space?     Yes No

If "no" - please explain why

6.     Can you sit comfortably?    Yes No

  If "no" - please explain the problem:

7.     Do you know how to adjust your workstation (chair, desk, equipment positions)?    Yes No A bit

8.     Do you ever have to do any uncomfortable activities that involve stretching, lifting , pushing, pulling or gripping?

Yes No - if "YES", what are the activities?

9.     Do you ever have any persistent or recurring discomfort?    Yes No

If you answered "Yes" - what is/are the problem('s)? -

Headaches;

Sore neck;

sore eyes ;

Shoulders;

Elbow(s);

Wrists, hands, fingers;

Mid-back;

Low back;

Other

If you selected "other", what is it?

10.     Can you always see and read your screen comfortably?    Yes No

If "no", why?

11.     Can you read your source papers and documents comfortably and easily?    Yes No

If "no", why?

12.     Are you satisfied with the present height and position of your screen?    Yes No

If "no", why?

13.     Can you always hear clearly?    Yes No

  If "no", why?

14.     What, if any, are the most tiring aspects of your work?

15.     Can you suggest any new arrangements or changes you believe would make your work more comfortable?

16.     Can you suggest any changes which would help you work more efficiently?

17.     Do you have any other suggestions for improvement?

18.     About yourself:

Your name: 

Your email address:

Where exactly in the building do you sit? (briefly describe your location, and if  relevant, details of your immediate surroundings and orientation to walls and any windows )

To validate this email, please enter your employer's name here:

Please tick here if you would like to discuss any of your comments or information needs with a consultant.

 

Thanks for completing this form. If you are interested in further information about how to set up your workstation, learning about organising your office, and about safety and health generally, you are invited to visit our website.