Module 4 - Employee input on potential ergonomics-related hazards

Instructions

1. Document the job title or task, the date and your name (optional).
2. Consider whether you think the objects are heavy, or the task is difficult/tiring.
3. Consider whether you perform a task repeatedly or for a long period of time.
4. Consider whether you adopt an awkward posture repeatedly or for a long period of time.
5. Check the appropriate box(es) that apply to the job/task
   
   
   1. Only make a check mark when the specific hazard exists and when you believe that it is difficult, tiring, heavy, done repeatedly, or done for a long time.
6. Writenotes for any identified hazard to clarify the task or activity where it occurs.
7. Return the completed forms to your manager/supervisor or health and safety representative or health and safety committee member.

Note:

If the physical demands related to the activity vary from day to day, due to different products/services being produced or provided, complete the checklist considering a more demanding day and then reuse the tool for a typical day.

Some ergonomics-related hazards, (e.g. lighting, aspects of work organization) are not addressed in this tool. If these or other ergonomics-related hazards exist, make note of them and any other concerns.

Job/task information:

Job title or task:

Date completed:

Completed by (optional):

General comments:

Musculoskeletal injury (MSI) hazards - Gripping		Check if required
Pinch gripping	Work with unsupported objects(s).
	Find it difficult/tiring holding or manipulating object(s).
	Find it difficult/tiring squeezing to open/close.
Power gripping	Work with unsupported heavy object(s).
	Find it difficult/tiring holding or manipulating object(s).
	Find it difficult/tiring squeezing to open/close.
	Notes:

MSI hazards - Awkward/fixed posture		Check if required
Awkward posture (Do you frequently assume these postures and/or hold them for a long time?)	Work with neck bent forward (chin close to chest).
	Work with neck bent to one side (ear close to shoulder).
	Work with neck twisted to either side/chin close to shoulder.
	Work with neck bent back.
	Work with neck bent forward and chin out (head forward).
Awkward posture (Do you frequently assume these postures and/or hold them for a long time?)	Work with hand(s) at/or above the head.
	Work with elbow(s) at/or above the shoulder.
	Work with elbows/hands behind the body.
Awkward posture (Do you frequently assume these postures and/or hold them for a long time?)	Work while sitting or standing with the back noticeably bent forward, sideways or twisted.
	Work with back noticeably bent backward with no support for the back.
	Work while squatting/kneeling.
Awkward posture (Do you frequently assume these postures and/or hold them for a long time?)	Work with wrist noticeably bent down or up.
	Work with wrist noticeably bent to the side (toward thumb/little finger).
	Work with hand turned so palm faces fully up or down.
Fixed posture	Work while sitting for long periods without standing (office work, driving).
	Work while standing still on a hard surface for a long period of time.