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Office Ergonomic Assessment Form
QEC Assessment
• Quick Exposure Check (QEC) •
• QEC is used to assess exposure to work-related musculoskeletal risk factors affecting the back, shoulder/arm, wrist/hand, and neck •
Worker's Name:
*
First
Last
Worker's Job Title:
*
Task:
*
Assessment Conducted By:
*
First
Last
Date:
*
MM slash DD slash YYYY
Time:
*
:
Hours
Minutes
AM
PM
AM/PM
Action(s) Required:
*
Observer's Assessment
BACK - (A) When performing the task, is the back
*
A1 - Almost neutral?
A2 - Moderately flexed or twisted or side bent?
A3 - Excessively flexed or twisted or side bent?
(select worse case situation)
BACK - (B) Select ONLY ONE of the two following task options:
*
PLEASE CHOOSE ONE
Seated or Standing Stationary Tasks
For Lifting, Pushing/Pulling and Carrying Tasks (i.e. moving a load)
Does the back remain in a static position most of the time?
*
B1 - NO
B2 - YES
Is the movement of the back...
*
B3 - Infrequent (around 3 times per minute or less)?
B4 - Frequent (around 8 times per minute)?
B5 - Very frequent (around 12 times per minute or more)?
SHOULDER/ARM - (C) When the task is performed, are the hands
*
C1 - At or below waist height?
C2 - At about chest height?
C3 - At or above shoulder height?
(select worse case situation)
SHOULDER/ARM (D) Is the shoulder/arm movement
*
D1 - Infrequent (some intermittent movement)?
D2 - Frequent (regular movement with some pauses)?
D3 - Very frequent (almost continuous movement)?
WRIST/HAND (E) Is the task performed with
*
E1 - An almost straight wrist?
E2 - A deviated or bent wrist?
(select worse case situation)
WRIST/HAND (F) Are similar motion patterns repeated
*
F1 - 10 times per minute or less?
F2 - 11 to 20 times per minute?
F3 - More than 20 times per minute?
NECK (G) When performing the task, is the head/neck bent or twisted?
*
G1 - No
G2 - Yes, occasionally
G3 - Yes, continuously
Worker's Assessment
(H) Is the maximum weight handled MANUALLY BY YOU in this task?
*
H1 - Light (5 kg or less)
H2 - Moderate (6 to 10 kg)
H3 - Heavy (11 to 20kg)
H4 - Very heavy (more than 20 kg)
(J) On average, how much time do you spend per day on this task?
*
J1 - Less than 2 hours
J2 - 2 to 4 hours
J3 - More than 4 hours
(K) When performing this task, is the maximum force level exerted by one hand?
*
K1 - Low (e.g. less than 1 kg)
K2 - Medium (e.g. 1 to 4 kg)
K3 - High (e.g. more than 4 kg)
(L) Is the visual demand of this task
*
L1 - Low (almost no need to view fine details)?
*L2 - High (need to view some fine details)?
* If HIGH, please give details in the box below
* L - Additional Details
*
(M) At work do you drive a vehicle for
*
M1 - Less than one hour per day or Never?
M2 - Between 1 and 4 hours per day?
M3 - More than 4 hours per day?
(N) At work do you use vibrating tools for
*
N1 - Less than one hour per day or Never?
N2 - Between 1 and 4 hours per day?
N3 - More than 4 hours per day?
(P) Do you have difficulty keeping up with this work?
*
P1 - Never
P2 - Sometimes
*P3 - Often
* If OFTEN, please give details in the box below
* P - Additional Details
*
(Q) In general, how do you find this job
*
Q1 - Not at all stressful?
Q2 - Mildly stressful?
*Q3 - Moderately stressful?
*Q4 - Very stressful?
* If MODERATELY or VERY, please give details in the box below
* Q - Additional Details
*
QEC Exposure Scores
Back
BACK SCORE (Static) TOTAL
(Sum of Back Scores - Static)
BACK SCORE (Material Handling)
(Sum of Back Scores - Material Handling)
Shoulder/Arm
SHOULDER/ARM TOTAL
(Sum of Shoulder/Arm Scores)
Wrist/Hand
WRIST/HAND TOTAL
(Sum of Wrist/Hand Scores)
Neck
NECK TOTAL
(Sum of Neck Scores)
Driving
DRIVING TOTAL
Vibration
VIBRATION TOTAL
Work pace
WORK PACE TOTAL
Stress
STRESS TOTAL
©2020 Peak Ergonomics, Inc
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