ERGONOMICS RISK FACTOR CHECKLIST - PDF Document

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  1. ERGONOMICS RISK FACTOR CHECKLIST UPPER EXTREMITY RISK FACTOR CHECKLIST Date: Analyst: Job: Location: RISK FACTOR CATEGORY RISK FACTORS EXPOSURE Is the risk factor present within the job or task? TIME SCORE 0% to 25% of total job time 25% to 50% of total job time 50% to 100% of total job time If total time for job is > 8 hours, add 0.5 per hour Upper Limb Movements 1. Moderate: Steady motion with regular pauses 0 1 2 YES NO 2. Intensive: Rapid steady motion without regular pauses 1 2 3 YES NO Keyboard Use 3. Intermittent keying 0 0 1 YES NO 4. Intensive keying 0 1 3 YES NO Hand Force (Repetitive or Static) 5. Squeezing hard with the hand in a power grip 0 1 3 YES NO 6. Pinch more than two pounds 1 2 3 YES NO Awkward Postures 7. Neck: Twist/Bend • Twisting neck > 20° 20o 20o 0 1 2 YES NO • Bending neck forward > 20° or back < 5° 8. Shoulder: Unsupported arm or elbow above mid-torso height 1 2 3 YES NO

  2. RISK FACTOR CATEGORY RISK FACTORS EXPOSURE Is the risk factor present within the job or task? TIME SCORE 0% to 25% of total job time 25% to 50% of total job time 50% to 100% of total job time If total time for job is > 8 hours, add 0.5 per hour 9. Rapid forearm rotation 0 1 2 YES NO 10. Wrist: Bend or deviate 1 2 3 YES NO Contact Stress 11. Hard/Sharp objects press into skin 0 1 2 YES NO 12. Using the palm of the hand or wrist as a hammer 1 2 3 YES NO Vibration 13. Localized vibration (without dampening) 0 1 2 YES NO 14. Whole-body vibration (without dampening) 0 1 2 YES NO Environment 15. Lighting (poor illumination or glare) 0 0 1 YES NO 16. Adverse temperatures 0 0 1 YES NO Lack of Control Over Work Pace (e.g., conveyor speed) 17. One control factor present = 1 YES NO Two or more control factors present = 2 TOTAL UPPER EXTREMITY SCORE

  3. BACK AND LOWER EXTREMITY RISK FACTOR CHECKLIST RISK FACTOR CATEGORY RISK FACTORS EXPOSURE Is the risk factor present within the job or task? TIME SCORE 0% to 25% of total job time 25% to 50% of total job time 50% to 100% of total job time If total time for job is > 8 hours, add 0.5 per hour Awkward Postures 18. Mild forward or side bending of the torso: More than 20°, but less than 45° 0 1 2 YES NO 19. Severe forward bending of torso, more than 45˚ 1 2 3 YES NO 20. Backward bending of torso up to 30° 0 1 2 YES NO 21. Twisting of torso 1 2 3 YES NO 22. Prolonged sitting without adequate back support 0 1 2 YES NO 23. Standing stationary or inadequate foot support while seated 0 0 1 YES NO

  4. RISK FACTOR CATEGORY RISK FACTORS EXPOSURE Is the risk factor present within the job or task? TIME SCORE 0% to 25% of total job time 25% to 50% of total job time 50% to 100% of total job time If total time for job is > 8 hours, add 0.5 per hour 24. Foot action (e.g., pedal), standing stationary with inadequate foot support, balancing 0 1 2 YES NO 25. Kneeling/Squatting 1 2 3 YES NO 26. Hip abduction (repetitive/ prolonged) 0 1 2 YES NO 27. Repetitive Ankle Extension/Flexion 0 1 2 YES NO Contact Stress 28. Hard/Sharp objects press into skin 0 1 2 YES NO 29. Using the knee as a hammer or kicker 1 2 3 YES NO Vibration 30. Whole-body vibration (without dampening) 0 1 2 YES NO

  5. RISK FACTOR CATEGORY RISK FACTORS EXPOSURE Is the risk factor present within the job or task? TIME SCORE 0% to 25% of total job time 25% to 50% of total job time 50% to 100% of total job time If total time for job is > 8 hours, add 0.5 per hour Push/Pull 31. Moderate load 0 1 2 YES NO 32. Heavy load 1 2 3 YES NO Lack of Control Over Work Pace 33. One control factor present = 1 YES NO Two or more control factors present = 2 (e.g., conveyor speed) MANUAL HANDLING CHECKLIST SCORE (Add STEP II score and STEP III score from page five and insert total here) TOTAL BACK AND LOWER EXTREMITY SCORE

  6. MANUAL MATERIALS HANDLING CHECKLIST 34(a). STEP I: NEAR LIFT MIDDLE LIFT FAR LIFT Determine if the lift is near, middle or far (body to hands) Horizontal Distance • Use an average horizontal distance if a lift is made every 10 minutes or less. • Use the largest horizontal distance if more than 10 minutes pass between lifts. 34(b). STEP II: NEAR LIFT MIDDLE LIFT FAR LIFT Estimate the weight lifted (pounds) More than 28 lb. More than 35 lb. More than 51 lb. DANGER ZONE DANGER ZONE DANGER ZONE Weight • Use an average weight if a lift is made every 10 minutes or less. 6 points 6 points 5* points CAUTION ZONE 17 to 51 lb. 12 to 35 lb. 10 to 28 lb. CAUTION ZONE CAUTION ZONE • Use the heaviest weight if more than 10 minutes pass between lifts. 3 points 3 points 3 points • Enter 0 in the total score if the weight is 10 pounds or less. Less than 10 lb. Less than 12 lb. Less than 17 lb. SAFE ZONE SAFE ZONE SAFE ZONE 0 points 0 points 0 points *If lifts are performed more than 15 times per shift, use 6 points. STEP II SCORE: Occasional lifts (<1 hour/shift) Frequent lifts (>1 hour/shift) 34(c). STEP III: Factor Determine the points for other risk factors 35. Twist torso during lift 1 1 36. Lift one-handed 1 2 Other Risk Factors • Use occasional lifts if more than 10 minutes pass between lifts. 37. Lift unexpected loads 1 2 38. Lift 1-5 times/minute 1 1 • Use the frequent lifts points if the risk factor occurs with most lifts and lifting is performed for more than one hour. 39. Lift > 5 times/minute 2 3 40. Lift above the shoulder 1 2 41. Lift below the knuckle 1 2 42. Carry objects 10-30 feet 1 2 43. Carry objects > 30 feet 2 3 44. Lift while seated or kneeling 1 2 STEP III SCORE: SW70XXE-26/09/18