1
Ergonomic Screening Assessment
(Appendix 4)
Work equipment
photograph
Work Equipment Title
Serial
Number/identification
mark
Work Equipment Group
Work Equipment Details
Project Manager
(contact details)
NOTE: This is a preliminary assessment which may lead to a more detailed
ergonomic assessment depending upon the answers to the following questions. If
any of the answers to the questions below are No remedial action or a more
detailed assessment will be required. Contact Jane Dillon or Corinne Parsons if
you need help to complete the assessment. Reference should be made to the
illustrations Fig 1, Fig 2, Fig 3 when answering these questions
1
1.1
1.2
1.3
1.4
1.5
2
2.1
2.2
2.3
For this equipment …….
Yes
No
N/A
If No state what
remedial action required
Detailed
assessment
required Y/N
N/A
If No state what
remedial action required
Detailed
assessment
required Y/N
Is the equipment less
than 16kg total weight?
If yes go to Question
1.2, if no go to
Question 1.3
Will suitable handles be
provided for lifting and
carrying the equipment?
If the equipment exceeds
16kg total weight will
alternative means of
transporting be
provided? (wheels for
example)
Are all visual
aids/instructions that
form part of the
equipment clear and easy
to understand?
Is the working space
where this equipment is
likely to be used
adequate i.e. unlikely
to be congested or
cramped?
For this equipments
intended use (so far as
can be ascertained) …….
Will all the lifting
tasks be within the HSE
guideline figures, (see
Fig 1)?
Will all the lifting
tasks be repeated 7
times/min or less
frequently?
Will all the forces
Ergonomic Assessment
Date: May 2013
Yes
No
Template Owner: S. White
Version: 2.0
2
2.4
2.5
2.6
2.7
2.8
2.9
2.10
2.11
2.12
2.13
2.14
2.15
2.16
required to keep a load
in motion require little
effort (e.g. be less than
7kg)?
Will all the forces
required to initiate
movement easy to exert
(e.g less than 15kg)?
Will all the pushing
forces required be
exerted with hands
between knuckle and
shoulder height?
Will all forces or items
lifted whilst seated be
less than 5kg?
Will any items to be
carried in the hands
weigh less than 10kg and
need carrying for less
than 1 minute at time?
Can all lifting and
handling tasks be carried
out without twisting or
bending?
Are all tasks completed
within the Golden Zone,
(AA or A on Fig 3)?
Will shorter or taller
people find reaching or
seeing to complete task
elements involving this
equipment easy?
Are work surface heights
appropriate? (e.g. around
700mm for seated work,
950 – 1000mm for standing
work; reduced to
accommodate items placed
on work surface or use of
tools. Bag tipping
heights below 500 mm)
Are all movements likely
as part of using this
equipment Low or Medium
risk 2 on the Muri chart,
(see Fig 2, ignore
walking)
Are all postures on the
Muri chart scoring Medium
or High held for less
than 1 minute at a time
or repeated less than 7
times/min, (see Fig 2,
Ignore walking)?
Can suitable time be
allowed in any task using
this equipment for rest
and recovery?
Can suitable seats be
provided for all tasks
that can be done seated?
Where this equipment is
used for tasks lasting
longer than one hour and
cannot be done seated
will provision been made
Ergonomic Assessment
Date: May 2013
Template Owner: S. White
Version: 2.0
3
to allow sitting down
during breaks?
ERGONOMIC ASSESSMENT
I can confirm that I have the appropriate level of competency, in terms of
knowledge and experience of completing other assessments, to allow me to sign
off this preliminary Ergonomic assessment. I can confirm that on completion of
the assessment and any remedial actions that are identified as necessary and no
significant risks are identified and still outstanding then this work equipment
is fit for purpose and the intended use to which it will be put within the
Business as far as its ergonomic impact is concerned, and that the user of the
work equipment or persons who may be affected by its use have been safeguarded
from any risks.
NOTE: If remedial actions highlighted in the remedial action column indicate
that a more detailed Ergonomic assessment report is required then the
ergonomists Jane Dillon or Corinne Parsons should be contacted for advice.
Work Equipment
Title
Assessment date:
(as per page one)
Assessor name
(Not valid unless
signed)
Assessor
signature
(not valid unless
signed)
The assessors must retain a copy of this Ergonomic assessment and forward a copy
to the Project Manager if the assessor and the project manager aren’t one and
the same person.
End of ERGONOMIC Assessment
Fig 1: HSE Lifting and Handling Guideline Figures
Fig 2: Muri Chart
Ergonomic Assessment
Date: May 2013
Template Owner: S. White
Version: 2.0
4
Ergonomic Assessment
Date: May 2013
Template Owner: S. White
Version: 2.0
5
Fig 3: Golden Zone
C
1700
1400
1150
900
Ergonomic Assessment
Date: May 2013
Template Owner: S. White
Version: 2.0