Task Description:
Date:
7step by step# specify posture# weights# fre8uency# environmental# physical factors# existing in9ury etc.:
Risk Factor
7i.e. (* < reason for (*# (dditional ris% factors should also be explored# such as distance traveled# load characteristics# uneven floors# etc.:
Action tems :
Assigne! to
7;ist names < assign date for completion:
Re"ise! RR #ack:
Shou$!er%Arm:
Wrist%&an!:
'eck:
Sta($e #ase:
)i(ration:
Work *ace:
En"ironment:
Re"ie+e! #y:
7(rea =anager > !ign<Date:
Appro"e! #y:
7-! > !ign<Date:
'ote ,: Stress as mentioned in section Q must consider nvironmental stressors# such as temperature, humidity, lighting, noise etc. !hould any such factor be rated as Moderate or more a 8uantitative reading must be noted 'in ?@ section+ for comparison with appropriate guidanceAstandards. 'ote -: "or any ;T( or where a significant doubt exists# the -<! manager must be informed so that a more comprehensive assessment can be initiated.
&age 1 of .
8orkers name
7ate
Observers Assessment
Back
A A1 A2 A3 When performing the task, is the back (select worse case situation) Almost neutral? Moderately flexed or twisted or side bent? Excessively flexed or twisted or side bent? O !" O E of the two following task
8orkers Assessment
8orkers
% %1 %2 %3 %1 < <1 <2 <3 = Is the ma imum weight handled !A"#A$$% &% %'# in this task? !i(,t .3 k( or less/ Moderate .; to 19 k(/ %eavy .11 to 29k(/ 4ery ,eavy .more t,an 29 k(/ 'n average, how much time do (ou spend per da( on this task? !ess t,an 2 ,ours 2 to 1 ,ours More t,an 1 ,ours When performing this task, is the ma imum force level e erted b( one hand? !ow .e)() less t,an 1 k(/ Medium .e)() 1 to 1 k(/ %i(, .e)() more t,an 1 k(/ Is the visual demand of this task !ow .almost no need to view fine details/?
'or seated or standin( stationary tasks) Does the back remain in a static position most of the time? B1 B2 O& 'or liftin(* +us,in(-+ullin( and carryin( tasks .i)e) movin( a load/) Is the movement of the back B3 B1 B3 #nfre0uent .around 3 times +er minute or less/? 're0uent .around 2 times +er minute/? 4ery fre0uent .around 12 times +er minute or o "es
=1 =2 =3 ! !1
5,oulder-Arm
6 61 62 63 7 71 72 73 When the task is performed, are the hands (select worse case situation) At or below waist ,ei(,t? At about c,est ,ei(,t? At or above s,oulder ,ei(,t? Is the shoulder/arm movement #nfre0uent .some intermittent movement/? 're0uent .re(ular movement wit, some +auses/? 4ery fre0uent .almost continuous movement/?
%i(, .need to view some fine details/? )!2 ) If High, please give details in the box below M M1 M2 M3 At work do (ou drive a vehicle for !ess t,an one ,our +er day or More t,an 1 ,ours +er day? At work do (ou use vibrating tools for 1 2 3 > >1 >2 !ess t,an one ,our +er day or More t,an 1 ,ours +er day? Do (ou have difficult( keeping up with this work? ever 5ometimes ever? Between 1 and 1 ,ours +er day? ever? Between 1 and 1 ,ours +er day?
8rist-%and
E E1 E2 ' '1 '2 '3 Is the task performed with (select worse case situation) An almost strai(,t wrist? A deviated or bent wrist? Are similar motion patterns repeated 19 times +er minute or less? 11 to 29 times +er minute? More t,an 29 times +er minute?
Often )>3 ) If Often, please give details in the box below ? In general, how do (ou find this *ob ot at all stressful? Mildly stressful?
eck
: :1 :2 :3 When performing the task, is the head/neck bent or twisted? o "es* occasionally "es* continuously , ! and " if appropriate
?1 ?2
Moderately stressful? )?3 4ery stressful? )?1 ) If Moderately or Ver y, please give details in the box below
)?
7ate 8rist-%and
.epeated !otion .'/ , /orce .=/ '1 =1 =2 =3 2 1 ; '2 1 ; 2 '3 ; 2 19 5core 1 5core 1
5,oulder-Arm
-eight .6/ , Weight .%/ 61 %1 %2 %3 %1 5core 1 2 1 ; 2 62 1 ; 2 19 63 ; 2 19 12 A2 ; 2 19
12
eck
"eck +osture .:/ , Duration .</ :1 :2 :3 <1 <2 <3 2 1 ; 1 ; 2 ; 2 19
5core 1
A3
2 1 ;
2
1 ; 2
19
&ack +osture .A/ , Duration .</ A1 A2 A3 <1 <2 <3 2 1 ; 1 ; 2 ; 2 19 5core 2 Duration .</ , Weight .%/ <1 %1 %2 %3 %1 2 1 ; 2 <2 1 ; 2 19 <3 ; 2 19 12 5core 3
.epeated !otion .'/ , Duration .</ '1 <1 <2 <3 2 1 ; '2 1 ; 2 '3 ; 2 19 5core 2
Duration .</ , /orce .=/ <1 =1 =2 =3 2 1 ; <2 1 ; 2 <3 ; 2 19 5core 3 $otal score for eck 5um of 5cores 1 to 2
7rivin(8orkers
Assessment
M1 1 M2 M3 1 @
4ibration
1 1 1 2 @ 3
$otal for 4ibration /re1uenc( .7/ , Duration .</ 71 <1 <2 <3 5core 3 2 1 ; 72 1 ; 2 73 ; 2 19 5core 3 <1 <2 <3 1 ; ; 2 5core 3 $otal for 8ork +ace >1 1 >2 1 >3 @ Wrist +osture .E/ , Duration .</ E1 2 E2 1
%1 %2 %3 %1
2 1 ; 2
1 ; 2 19
; 2 19 12
8ork +ace
5tress
?1
5cores 1 to 3 +lus 3 and ;
?2 ?3
?1
1 1 @ 1; 5um of 5cores 1 to 3
$ac%: !houlderA(rm: ,ristA-and: Bec%: !table $ase Cibration: ,or% &ace: nvironment:
Assessment Scores -,231 3,241 -,231 3,241 -,231 3,241 72,1 4 4 4 4 ,,2,4 9 9 9 9
Where <perations are repeate! 5nce or twice per minute "ive to eight times per minute =ore than 1/ times per minute
&age . of .