Workplace Ergonomics Assessment

Workplace Ergonomics Assessment — Form Fields

This hr template includes 8 fields. Workplace ergonomics assessment form for evaluating employee workstation setup, identifying discomfort, and recommending adjustments. Helps employers reduce injury risk and improve comfort. Free to customize and use on ZenBuild.

• Employee Name (text, required)
• Department (text, required)
• Primary Work Location (dropdown selection, required) — options: Office desk, Home office, Standing desk, Shared / hot desk, Other
• Average Hours at Desk Per Day (number, required)
• Current Equipment (select all that apply) (checkboxes, optional) — options: External monitor, External keyboard, External mouse, Monitor stand or arm, Footrest, Ergonomic chair, Wrist rest
• Areas of Discomfort (select all that apply) (checkboxes, optional) — options: Neck, Shoulders, Upper back, Lower back, Wrists / hands, Eyes / vision, None
• Is your monitor at eye level when seated? (multiple choice, required) — options: Yes, No, too high, No, too low, Not sure
• Additional Comments or Equipment Requests (long text, optional)