Professional Documents
Culture Documents
SAMPLE Ergonomic Risk Assessment
SAMPLE Ergonomic Risk Assessment
Identify where exposures are highest and focus intervention to such areas
To score the exposure assessment
1. Use the Exposure Scores sheet to determine the scores for each body area. For example, at
the top left hand corner of the sheet for the Back:
The first table shows the scores for combinations Posture (A1-3) and Weight (H1-4).
Identify the corresponding exposure combination, e.g. the combination A2 and H2
would score 6, for A3 and H3 score 10. Enter this in the Score 1 box at the bottom
right-hand corner.
Do this for the correct combination of factors for the back, i.e. by calculating either
scores 1 to 5 OR scores 1 to 3 plus score 6 as applicable
Task Description:
Location:
Assessment Team:
[List names of all participants]
Date:
[step by step, specify posture, weights, frequency, environmental, physical factors, existing injury etc.]
Risk Factor
Action Items :
Assigned to
[List names & assign
date for completion]
Revised RR
Back:
Shoulder/Arm:
Wrist/Hand:
Neck:
Stable Base:
Vibration:
Work Pace:
Environment:
Reviewed By:
Approved By:
[HSE Sign&Date]
Note 1: Stress as mentioned in section Q must consider Environmental stressors, such as temperature, humidity,
lighting, noise etc. Should any such factor be rated as Moderate or more a quantitative reading must be noted (in *Q
section) for comparison with appropriate guidance/standards.
Note 2: For any LTA or where a significant doubt exists, the H&S manager must be informed so that a more
comprehensive assessment can be initiated.
Page 1 of 4
Workers name
Observers Assessment
Back
A
Date
Workers Assessment
Workers
H
H1
Light (5 kg or less)
A1
Almost neutral?
H2
Moderate (6 to 10 kg)
A2
H3
A3
H4
B Select
options:
EITHER
For seated or standing stationary tasks. Does the
back remain in a static position most of the time?
B1
No
B2
Yes
J
J1
J2
2 to 4 hours
J3
OR
K1
B3
K2
B4
K3
B5
Shoulder/Arm
C
C1
C2
C3
D1
D2
D3
Wrist/Hand
E
L
L1
M1
M2
M3
N1
N2
N3
E1
E2
P1
Never
P2
Sometimes
F1
F2
F3
Often
*P3
* If Often, please give details in the box below
Q
Neck
G
G1
No
G2
Yes, occasionally
G3
Yes, continuously
Q1
Q2
Mildly stressful?
Moderately stressful?
*Q3
Very stressful?
*Q4
* If Moderately or Ver y, please give details in the box below
*Q
A2
Date
Shoulder/Arm
Wrist/Hand
Neck
A3
C1
C2
C3
F1
F2
F3
H1
H1
K1
J1
H2
H2
K2
J2
H3
10
H3
10
K3
10
J3
10
H4
10
12
H4
10
12
Score 1
Back Posture (A) & Duration (J)
A1 A2 A3
Score 1
Score 1
Score 1
C2
C3
F2
F3
J1
J1
J1
J1
J2
J2
J2
J2
J3
10
J3
10
J3
10
J3
Score 2
Score 2
Score 2
Score 2
J2
J3
H1
H2
H3
10
H4
10
12
Score 3
J1
J2
J3
H1
H2
H3
H4
J1
J2
J3
K1
K2
10
K3
10
10
12
B1
B2
J1
J2
J3
K1
K2
10
K3
10
12
H1
H2
H3
H4
H2
H3
H4
6
8
8
10
M1
J1
J2
12
Vibration
N1
1
J3
D1
D2
D3
10
E2
J2
J3
10
N3
J1
J2
J3
Score 5
P1
1
P2
P3
Score 5
Total for Work pace
Stress
Q1
Score 6
Total score for Back
Sum of scores 1 to 4 OR
N2
Work pace
Score 5
B5
Score 4
10
B4
B5
B3
M2 M3
Score 4
H1
D3
B4
Assessment
1
E1
D2
B3
DrivingWorkers
Score 3
Score 4
Score 3
Q2 Q3
Q4
1
4
9
16
Sum of Scores 1 to 5
Low
Back:
Shoulder/Arm:
Wrist/Hand:
Neck:
Stable Base
Vibration:
Work Pace:
Environment:
10-20
10-20
10-20
Moderate
High
Assessment Scores
21-30
31-40
21-30
31-40
21-30
31-40
Very
High
41-56
41-56
41-56
2-6
1
1
7-10
4
4
11-14
9
9
15-18
1
1
4
4
9
9
16
Figures should be
reduced by
30%
50%
80%
Page 4 of 4