Home Office Ergonomics Assessment

1. Personal Information

Name Department Date

2. Workstation Details

Chair Type Desk Type Monitor Size (inches) Laptop/Desktop Laptop Desktop

3. Ergonomics Checklist

Chair has adjustable height Feet rest flat on the floor Monitor at eye level Proper lighting No glare on screen Adjustable keyboard/mouse position

4. Concerns/Discomfort

Describe any discomfort or ergonomic concerns

5. Recommendations

Suggested Improvements