Remote Worker Ergonomic Self-Assessment

Basic Information

Name Email Position

Is your chair adjustable?

Yes No

Can your feet rest flat on the floor while seated?

Yes No

Is your monitor at eye level?

Yes No

Do you use an external keyboard and mouse?

Yes No

Describe any other equipment or accessories used:

How often do you take breaks from sitting?

Do you stretch or move regularly during your workday?

Yes No

Any discomfort or pain experienced during work?