An Integrated Methodology for Prioritising
Risk Potentials in Small and Medium Scale
Enterprises
S. A. Binoosh1, and G. Madhan Mohan2
1
PSG College of Technology, Coimbatore, India
Email: sabinoosh@yahoo.co.in
2
PSG College of Technology, Coimbatore, India
Email: gmadhanmohan@yahoo.co.in
Abstract—Identification and evaluation of work
related physical exposure of workers in small and
medium enterprises (SMEs) are credential to avoid
the prevalence of risk in the form of musculoskeletal
disorders. The jobs that involve complaints from
workers regarding pain, discomfort or other health
problems due to work and jobs with ineffective
recovery time are critical for formation of disorders.
This study aims to investigate potential of risk in
critical jobs within the SMEs for prioritising it. In order
to achieve the objective, a four phased integrated
methodology has been developed. The initial phase of
the methodology consists of selection of critical jobs
based on the discussions with the managerial and
supervisory staff and by screening of time study data.
A self-reporting method based on Cornell discomfort
survey, NIOSH discomfort survey and Nordic
questionnaire has been included for identifying the
discomfort in second phase. In third phase, an
observation method based on PLIBEL and Quick
Exposure Checklist has been used for postural
evaluation. The final phase consists of prioritisation
of the selected jobs based on analysis of collected
data and deriving guidelines for ergonomic
interventions. The methodology has been applied in a
medium scale industry and four critical jobs have
been selected from production process of mixed flow
type submersible pump, based on discussions with
authorities and time study data. Structured interviews
with questionnaire and checklist have been
conducted among operators of specific jobs and
sample jobs have been recorded by using digital
camera for reviewing the observations. Statistical
analysis has been conducted and results indicate that
the selected jobs have high potential of discomfort
and Stage Casing (Drilling & Tapping) job has become
most critical. The suggestions have been made for
conducting ergonomic interventions.
Index Terms—musculoskeletal disorders, postural
evaluation, discomfort index, risk index, ergonomic
interventions
I. INTRODUCTION
Work related musculoskeletal disorders (WMSDs)
are becoming a major health problem around the
Corresponding author: S.A.Binoosh; Tel.:+91 8148228810
world amongst workers involved in various
occupations including manufacturing activities [1]-
[7]. Physiological exposures of work in
manufacturing activities are more seen in small and
medium enterprises (SMEs) and these activities are
prominent in generating disorders. WMSDs affect
the organisational level by the reduction of
productivity, and quality of output as well as it
increases cost related to the compensation to the
workers and labour turnover problems [8]. The
assessment and analysis of musculoskeletal risk
involved in the physiological exposure of work with
self-reports and observation methods will give
adequate insights to solve the problem. It will also
provide suitable interventions to reduce fatigue and
guidelines for limiting the amount of exposure to
physical work in order to reduce undesired
consequences [9].
Self-report methods are widely used for the
assessment of risk of WMSDs through discomfort
surveys or structured interviews. They are very easy
to administrate and economical to use for various
work situations. Key factors in self-reports includes
location, intensity, frequency and duration of
discomfort of the worker related to the work related
activities. Self-reports make use of body maps to
indicate location of discomfort and rating scales are
used to measure the underlying parameters in
various body locations [10]. The simultaneous
assessment of intensity and frequency of discomfort
in self-reports helps the early detection of disorders
[11]. The duration of discomfort in self-reports allows
the ergonomists to discriminate the sources of
discomfort which can be reduced or eliminated by
ergonomic interventions [10]. According to
Westgaard and Winkel, ―ergonomic intervention is a
change process initiated and implemented by a
stake holder with the aim to introductory measures
that influences occupational exposures‖[12]. But
self-reports are more constrained to physiological
discomfort. The psychophysical discomfort also
affects physical activities [13] and it is to be
incorporated to assess the risk of WMSDs. The
assessment of psychophysical factors is included in
various observation methods.
 Observation methods are used for evaluating the
risk of physical exposures which lead to WMSDs
with a suitable checklist for making observations.
These methods are posture based and the
assessment can be done without interfering the
work and worker [14]. So it can be used very
conveniently for postural evaluation. But these
methods are more suitable for relatively static jobs
where the movements follow a simple pattern. The
load or force applied, repetition and duration of
movement are not simultaneously considered during
assessment process in posture based observation
techniques. These limitations of the observational
methods are addressed by incorporating it with
computer aided observations or with the support of
video recordings [14]-[15]. The integration of self-
reports and observation methods provide an
amenable solution for identifying the risk of
physiological exposures of work which leads to
WMSDs. Also the discrepancies between the
observer and worker assessment of work can be
reduced by the proper explanation of the aspects
such as motion, exertion and posture related to the
activities [16].
This paper describes an integrated approach for
identifying and analysing musculoskeletal disorders
among industrial workers engaged with
physiological exposure of work in manufacturing
activities by using an integration of self-report
methods and observation methods. The developed
methodology has been also applied in a medium
scale manufacturing industry to prioritise the risk of
WMSDs.
II. METHODOLOGY
A large number of methods are available for
assessing musculoskeletal discomforts. But there is
no single method to provide consensus in
application which makes difficulty in selection. [15],
[17]. Ergonomists needs a quick tool for addressing
wider issues of the organisation [14]. The integrated
methodology has been developed as a quick and
rapid tool to assess various physiological factors
related to work with consensuses in application in
SMEs. It has been developed based on a common
procedure and also incorporated with the methods
which measures psychological factors,
environmental factors and organisational risk factors
[18], [31]. The measures of external exposure of
work such as organisational factors will help the
investigator to evaluate work more accurately [19].
The developed methodology includes four phases
and the procedure to follow through phases is
shown in Fig. 1. The initial phase consists of the
selection of critical jobs within the SME. The
supervisors and managerial staff are aware of
complaints from workers regarding pain, discomfort
or other health problems due to work. The
discussions with these people provide valuable
information for selecting critical jobs, which are
Selection of critical jobs based on discussion
with managerial as well as supervisory staff PHASE 1
and screening of time study data
Conducting discomfort survey with an
integrated questionnaire based on Cornell
PHASE 2
discomfort survey, NIOSH discomfort survey
and Nordic questionnaire
Postural evaluation based on an integrated
checklist based on PLIBEL and QEC with PHASE 3
video recording sample jobs
Analysis of data after a proper review on the
jobs
PHASE 4
Prioritisation of selected jobs based on
analysis and provides guidelines for
ergonomic interventions
Figure 1. The procedure for prioritisation of risk potential
among critical jobs in integrated approach
prone to the risk of WMSDs. The time study data
provides details of cycle time and allowances
provided for the jobs. It should be utilized to
consider the aspect of recovery time for selection of
jobs. The ineffective recovery can act as an
accelerator of disorders [9].
Second phase of the methodology consists of
self-report questionnaires for conducting discomfort
surveys. Third phase consists of postural evaluation
by using checklists of observation methods. The
observational methods provide higher validity than
self-reports [15], but self-reports give valuable
insights in to the working condition [11]. The
accuracy of self-reports is affected by literacy of
workers, comprehensive ability and interpretation
[18]. The supplementary questionnaire in local
language is to be used for addressing this problem.
The self-report questionnaire has been developed
based on Cornell Musculoskeletal Discomfort
Questionnaire (CMDQ), NIOSH discomforts survey
and Nordic Musculoskeletal Questionnaire (NMQ)
and it is to be administrated through structured
interview to provide more reliability, response rate
and accuracy in data collection[19]-[20]. The
observation checklist has been developed based on
PLIBEL and Quick Exposure Checklist (QEC) and
data collection is to be done directly and it can be
reviewed with video recordings.
The final phase of the methodology consists of
analysis, prioritisation of the selected jobs and
providing guidelines for ergonomic interventions.
The retrieval of data from self-report questionnaires
and observation checklists are to be done for
conducting the analysis. Discomfort indices of body
sites are to be determined to identify the perceived
level of discomfort in selected jobs based on self-
reports. The overall risk indices of methods indicate
potential of risk in selected jobs. The mean value of
overall risk indices of methods provides the base for
prioritising jobs based on degree of risk. Qualitative
methods such as paired comparison method can
also be used for prioritisation of risk potential among
jobs. The postural analysis provides adequate
insights for ergonomic problems. The guidelines for
different interventions are to be developed based on
the same.
A. Descriptions and Validity of Basic Tools
CMDQ was developed based on research studies
in musculoskeletal discomforts [21]. It includes the
questionnaire for 20 body sites such as neck,
shoulder (right and left), upper arm (right and left),
lower back, forearm (right and left), wrist (right and
left), hip/buttocks, thigh (right and left), knee (right
and left), lower leg (right and left), foot (right and
left) in the questionnaire [22]. The discomforts such
as eye strain (left and right), headache and ankles
(left and right) are also includes in the web form of
Cornell University body discomfort survey [23]. The
validity and reliability of CMDQ was extensively
tested in Turkey and found good [24].
In NIOSH discomfort surveys body maps and
ratings are employed for multiple body regions and it
captures information regarding intensity, severity
and duration of discomfort. It includes 15 body sites
such as neck, shoulder (right and left), upper back,
elbow (right and left), low back, wrist/hand (right and
left), hip/thigh (right and left), knee (right and left),
and foot (right and left). NIOSH discomfort surveys
used in NIOSH studies shows strong content validity
and relevant construct validity [25].
NMQ was developed to use it as a self- report or
as a structured interview. It includes 9 body sites
such as neck, shoulders, upper back, elbows, low
back, wrists/hands, hips/thighs, knees and
ankles/feet. The questions include about
musculoskeletal problems in the last 12 months and
last 7 days and its effect on doing normal activity
[20]. NMQ has been applied to a wide range of
occupational groups to evaluate muscular skeletal
problems including call centre workers, car drivers,
coopers in whiskey industry, nursing and forestry
workers [26]. NMQ is also applied for workers
exposed to blue collar workers [27], hand arm
vibration [28], manual spray painting [29], foundry
workers [30], and veterinarians [7] in
musculoskeletal discomfort studies.
PLIBEL (identification of musculoskeletal stress
factors which may have injurious effects) is a simple
and rapid tool in the form of a checklist for
workplace investigation. It includes five body regions
such as: (a) neck, shoulder and upper back, (b)
elbows, forearms and hands, (c) feet, (d) knees and
hips and (e) low back. Individual, environmental and
organisational aspects are assessing in PLIBEL.
The criteria used in PLIBEL is validated with AET
(Arbeitswissenshaftliche Erhebungsverfahren zur
Tätigkeitsanalyse), the German ergonomic job
analysis procedure. It has also got inter observer
reliability ranging from fair to moderate [31].
QEC is an observation method for assessing the
exposures to the risk of WMSDs in quick manner
[14]. It includes the observer‘s questionnaire and
worker‘s questionnaire. The investigation area
includes shoulder/arm, wrist/hand and neck. It also
includes investigation of factors such as driving,
vibration, work pace and stress. The reliability of
QEC is acceptable and it has got higher level of
usability [32]-[33]. The QEC assesses the force,
posture repetition and duration of exposures [34].
B. Preparation of Tools for Data Collection
An integrated self-report and checklist has been
developed for easiness in data collection for
conducting discomfort survey and postural
evaluation respectively. The discomfort survey
questionnaire includes a body map to indicate 25
body sites such as neck, shoulder (right and left),
upper back, upper arm (right and left), lower back,
forearm (right and left), hand/wrist (right and left),
elbow (right and left), hip/buttocks, thigh (right and
left), knee (right and left), lower leg (right and left),
foot/ankle (right and left), eye strain (right and left)
and headache based on the body sites indicated in
Cornell, NIOSH and Nordic discomfort surveys. The
integrated questionnaire include four questions
which is to be answered corresponding to the body
locations. The first question is about the frequency
of discomfort and options such as: ‗never‘, ‗every 6
months‘, ‗every 2 to 3 months‘, ‗once in a month‘, ‗1-
2 times last week‘, ‗3-4 times last week‘, ‗since
every day‘ and ‗several times a day‘ have been
included. The second question is about intensity of
discomfort and options include ‗slightly
uncomfortable‘, ‗moderately uncomfortable‘, ‗very
uncomfortable‘ and ‗severely uncomfortable‘. The
third question is about duration of discomfort and
the option include ‗less than one hour‘, ‗one to 24
hours‘, ‗25 hours to 1 week‘ , ‗1 week to 2 week‘, ‗2
weeks to 1 month‘, ‗1 to 2 months‘ and ‗more than 3
months‘. The fourth question is about interference
with work/normal activities and options include ‗not
at all‘, ‗slightly interfered‘ and ‗substantially
interfered‘.
The data collection for observational method has
been done with a hybrid checklist based on PLIBEL
and QEC. The body regions of PLIBEL have been
used as a base and the QEC has been incorporated
in to it. The QEC questions with same content have
been integrated and other questions have been
appended. The integrated questions and appended
questions have been marked suitably with some
symbols for identification. The questions in
observer‘s questionnaire and the worker‘s
questionnaire in QEC have been marked as well.
The following questions in PLIBEL have modified
and all other questions of QEC have been
appended to provide a hybrid checklist. The first
modified question is about the repeated and
sustained work performed by back. It has been
modified with options such as ‗mildly flexed forward‘,
‗severely flexed forward‘, ‗moderately bend
sideways‘, ‗excessively bend sideways‘, ‗mildly
twisted‘, ‗severely twisted‘ and ‗almost neutral‘. In
the question about visual capacity the options of
QEC has also been included.
C. Data Retrieval and Analysis
The data related to the frequency, severity and
productivity in Cornell discomfort survey
(corresponds to questions first, second and fourth
questions in the integrated questionnaire) to be
entered in to the web format to get the MSD impact
score [23]. The weightings for frequency of
discomfort is to be taken as 0 (never), 1.5 (1-2 per
week), 3.5 (3-4 times per week) and 10 (several
times a day). The weighting of severity is 1 to 3
(‗slightly uncomfortable‘ to ‗very uncomfortable‘) and
productivity is to be assigned as 1 to 3 (‗not at all‘ to
‗substantially interfered‘) [21]. The ratio of MSD
impact score to the product of maximum expected
total weighted score of body sites for the parameters
provides the overall discomfort index for individual
worker. If more than one worker, the mean of overall
index is to be taken in to account. The ratio of
product of obtained weighted score of frequency,
severity and productivity of each body site to the
product of maximum expected weighted score of the
same will provide individual discomfort index of body
site.
The data related to NIOSH discomforted
questionnaire can be extracted from the response of
first three questions corresponding to frequency,
intensity and duration. The weightings are 1 (every
six month), 2 (every 2 to 3 month), 3 (once a
month), 4 (once a week) and 5 (daily). The
weighting of intensity is to be taken as 1 (mild), 2
(moderate), 3 (severe) and 4 (worst pain in life)
corresponding to first to fourth options in the
integrated questionnaire. The weighting of duration
is to be taken as 1 to 7 (‗less than 1 hour‘ to ‗more
than 3 months‘) corresponding to the questionnaire
[25]. The ratio of product of total weighted scores of
body sites for frequency, intensity and duration to
the product of maximum expected total score of
body parts for the same provides the overall
discomfort index of the individual worker. If there are
more workers, the mean value is to be taken in to
account. The ratio of product of obtained weighted
score of frequency, intensity and duration of each
body site to the product of maximum expected
weighted score of the same will provide its individual
discomfort index.
The data related to Nordic discomfort survey have
been extracted from the first and fourth questions of
the integrated questionnaire. From the first question
the data corresponding to the discomfort for last 12
months and last 7 days are to be accessed and from
the fourth question response to the interference is to
be accessed. The responds provide total discomfort
score for three questions corresponding to nine
body sites [20]. The risk index is to be calculated by
taking the ratio of total score to the maximum score
of 27. Similarly based on the responses for the
questions corresponding to each body site to the
maximum score of 3 will provide the body site index.
The maximum value of the overall index and
discomfort indices of body sites is unity for Cornell,
NIOSH and Nordic discomfort surveys. Based on
these discomfort surveys, discomfort indices of body
sites are to be calculated and mean index is to be
determined. Most of the body sites are common to
these discomfort surveys. It includes neck,
shoulders, upper back, lower back, wrists,
hip/buttocks, thighs, knees and feet/ankles. The
elbows are included in NIOSH and Nordic surveys.
Discomfort in elbows can also account from Cornell
discomfort survey by assuming the average effect of
upper arm and forearm. The remaining body sites in
Cornell survey such as eyes, headache and lower
legs should be analysed independently. The
potential body sites are to be analysed with postural
evaluation data also.
The data corresponding to PLIBEL can be
extracted to provide the score for each body
segment and the ratio of the score obtained to the
maximum score provides risk indices for body
segments as well as overall risk index [31]. The
QEC data for worker‘s as well as observer‘s
questionnaire is also be extracted from the
integrated questionnaire and the data related to the
back and visual capacity are to be accessed from
the modified questions in the integrated
questionnaire. The QEC indices for the body
segments as well as overall index is to be
determined from the ratio of the obtained score to
the maximum score [32]-[33]. The overall discomfort
indices and risk indices of regions / factors of
PLIBEL and QEC have a maximum value of unity.
III. APPLICATION
A. Subjects and Method
The developed method has been applied in a
medium scale manufacturing industry for the jobs
involved in production process of a mixed flow
submersible pump. Based on discussion with the
managerial as well as supervisory staff and time
study data, four jobs such as Pump Assembly,
Motor Assembly, OD Machining and Stage Casing
(Drilling & Tapping) have been selected as the
critical jobs for study. All workers engaging these
jobs have been taken for the study and they are
having more than one and a half years of
experience and belonging to age group ranging from
20 years to 60 years with a median of 23 years. The
stature height of workers is ranging from 153 cm to
172 cm with a median value of 168 cm. The weight
of workers is ranging from 50 kg to 65 kg with a
median value of 60 kg. It includes 4 workers in the
Pump Assembly, 3 workers in the Motor Assembly
and one worker each for OD Machining job and
Stage Casing (Drilling & Tapping).
The self- report questionnaire and features of
worker‘s assessment part in QEC have been
administrated through structured interview with the
workers in the work site itself. The observations by
using the checklists have been done while the
worker has engaged in work. The sample jobs have
been recorded with the help of Panasonic Lumix
TZ15 digital camera for reviewing the observations.
Same procedure of data collection has been
adapted for all the workers without interrupting their
work schedules. The observation checklists have
been reviewed with the sample recordings.
B. Results
The collected data has been retrieved for analysis
based on the basic methods used for integration
and statistical analysis has been done in
Minitab®15. The discomfort surveys provide 16
common body sites such as neck, shoulders, upper
back, lower back, elbows, wrists, hip/buttocks,
thighs, knees and feet/ankles in Cornell, NIOSH and
Nordic discomfort surveys. The comparative
analysis has been done and the mean discomfort
indices have been determined based on the same.
Only eyes, headache and lower legs in Cornell
discomfort survey provide additional data and they
have been analysed independently.
The discomfort indices of the common body sites
based on discomfort surveys for Pump Assembly
are shown in Fig. 2. The mean discomfort indices in
Pump Assembly show highest values for lower back
Figure 2. Discomfort indices of common body sites for Pump Assembly job
(0.3049) and shoulder (right) (0.2989). The Cornell,
NIOSH and Nordic discomfort indices supports the
same. Nordic indices show the highest values while
Cornell indices provide lesser values for discomfort
indices of body sites. The eyes and lower legs
provide zero indices and headache provides a
minute index of 0.0008 of Cornell discomfort survey.
The risk indices of PLIBEL and QEC in body
regions/factors for all selected jobs are shown in
Table I and Table II respectively. In Pump
Assembly, results of PLIBEL provides an index of
0.4500 for low back region, which is higher than the
overall risk index for the job and shoulder region
shows the highest regional index. In results of QEC
checklist shoulder/arm region shows the maximum
index of unity and back region shows a higher index
than overall index for the job. These results also
support the results of discomfort surveys. But the
neck region provides a higher risk index (0.8889),
which is not so evident in discomfort surveys. The
stress factor also provides a higher value.
For the Motor Assembly job the knees have got
highest value of mean discomfort index (0.3012).
The Cornell, NIOSH and Nordic discomfort indices
support the same with highest values. The wrist
(right) and lower back also got higher values of
discomfort. The discomfort indices of the common
body sites for Motor Assembly are shown in Fig. 3.
In Motor Assembly also Nordic indices show the
highest values while Cornell indices provide lesser
values for discomfort indices of body sites. The eyes
and lower leg provides zero indices and headache
provides a minute index of 0.0006 in Cornell
discomfort survey.
In Motor Assembly, the lower back shows the
highest risk in results of PLIBEL. The wrist region
shows a higher risk index than overall risk index.
These support the discomfort survey results. But the
risk for knee region is not much evident while it
provides highest discomfort based on discomfort
surveys. QEC results also show higher risk for back
 TABLE I. TABLE II.
PLIBEL RISK INDICES FOR SELECTED JOBS QEC RISK INDICES FOR SELECTED JOBS

Risk Indices Risk Indices

Machining
Body

(Drilling &
Assembly

Assembly

Machining
Assembly

Assembly

(Drilling.&
Tapping)

Tapping)
Body Regions /

Casing

Casing
Stage
Pump

Motor

Stage
Pump

Motor
Regions /

OD
Factors

OD
Factors

Neck, Back 0.8571 0.8571 0.7619 0.5714

Shoulder, 0.4800 0.4000 0.4400 0.4800
Upper Back Shoulder /
1.0000 0.8571 0.7500 0.6786
Elbows, Arm
Forearm and 0.4545 0.3636 0.4545 0.5455 Wrist/
Hands 0.8696 0.8696 0.7826 0.6957
Hand
Feet 0.2500 0.2500 0.2500 0.5000 Neck 0.8889 0.8889 0.8889 1.0000
Knee and Hips 0.2500 0.2500 0.2500 0.5000 Driving 0.1111 0.1111 0.1111 0.1111
Low Back 0.4500 0.4000 0.4000 0.4000
Vibration 0.1111 0.1111 0.1111 0.1111
Environmental
0.4000 0.4000 0.5000 0.6000 Work Pace 0.5556 0.5556 0.4444 0.4444
Factors
Overall Risk Stress 0.8906 0.4581 0.5625 1.0000
0.4146 0.3659 0.4024 0.4634
Index Overall
0.8256 0.7382 0.6878 0.6537
Risk Index
as well as wrist region. The neck region provides
the highest value of regional risk index in QEC.
For the OD Machining job the shoulders, wrists so evident. It also provides higher value for shoulder
and feet/ankles have got higher value of mean region. The environmental factor provides highest
discomfort (0.3159) and all self-report methods regional index. The QEC results also provide higher
supports it with higher values for the same. The risk indices for shoulder and wrist region than the
knees have shown a zero index in discomfort overall index. The neck region provides highest
surveys. The discomfort indices of the common value of regional risk index in QEC.
body Sites for OD Machining are shown in Fig. 4. In For the Stage Casing (Drilling & Tapping) job the
OD Machining job also Nordic indices show the wrist (right) and hip/buttocks have got highest value
highest values while Cornell indices provide lesser of mean discomfort index (0.3270) and all self-
values for discomfort indices of body sites. The report methods supports it with highest values for
headache provides zero index and eyes provide a the same. In Stage Casing (Drilling & tapping) job
least index (0.0033) while lower legs provide a lower also Nordic indices show the highest values while
index of 0.0233 in Cornell discomfort survey. Cornell indices provide lesser values for discomfort
Results from PLIBEL shows the highest regional indices of body sites. But Cornell discomfort indices
index for wrist region but the risk index of feet is not show the same values for all body sites. The

Figure 3. Discomfort indices of common body sites for Motor Assembly job
 Figure 4. Discomfort indices of common body sites for OD Machining job
discomfort indices of common body sites in Stage
Casing (Drilling & Tapping) are shown in Fig. 5. The
eyes and headache provide a lowest discomfort
index of 0. 0017 and lower legs provide a discomfort
index of 0.0233 in Cornell discomfort survey.
Results of PLIBEL provide one of the highest values
of risk index for wrist region and the risk of
hip/buttocks region is also evident as compared with
discomfort survey results. The environmental factor
provides highest regional index. The QEC results
also provide a higher risk for the wrist region than
the overall index. The neck region and stress factor
provide maximum value of risk index in QEC.
The overall risk indices and risk prioritisation for
selected jobs based on discomfort surveys and
postural evaluation are shown in Table III. The risk
potential for prioritizing jobs has been determined by
taking the mean value of overall risk indices of self-
Figure 5. Discomfort indices of common body sites for Stage Casing (Drilling & Tapping) job
reports and observation methods. The paired
comparison method has also been used to
prioritising the risk of selected jobs. It also provides
the same priority of risk as shown in Table III. The
Stage Casing (Drilling & Tapping) has got highest
priority and Motor Assembly has got least priority for
addressing risk and developing ergonomic
interventions. The QEC indices of all the jobs shows
high potential of discomfort which is not properly
reflected through discomfort surveys. The ANOVA
results show that discomfort indices of body sites
have significant difference (p < 0.05) and self-
reporting methods are independent in selected jobs.
Also it is seen that the differences between overall
indices of jobs are not significant at 5% level
(p = 0.139) and all basic methods applied for study
are independent.
 TABLE III.
OVERALL RISK INDICES OF JOBS AND PRIORITY FOR ADDRESSING RISK

Overall Risk Indices

Priority for
Mean Risk
Jobs Cornell NIOSH Nordic Addressin
Index
Discomfort Discomfort Discomfort PLIBEL QEC g Risk
Survey Survey Survey
Pump Assembly 0.0729 0.0728 0.5093 0.4146 0.8256 0.3790 2
Motor Assembly 0.0653 0.0493 0.5619 0.3659 0.7382 0.3561 4
OD Machining 0.1971 0.0583 0.5185 0.4024 0.6878 0.3728 3
Stage Casing (Drilling & Tapping) 0.4299 0.1993 0.6667 0.4634 0.6537 0.4826 1

results supports the risk of wrist (right) and lower

IV. DISCUSSIONS
The self-report questionnaire based on Cornell
discomfort survey, NIOSH discomfort survey and
Nordic questionnaire generated data for 25 body
sites for frequency, intensity and duration of
discomfort and effect of discomfort on productivity.
The basic methods for the self-report questionnaire
have been selected based on the concept of
addressing these parameters. The observation
methods have been selected based on the concept
of developing a quick and rapid tool for postural
evaluation of entire body. The features of QEC does
not taking in to account of the lower extremities
while the PLIBEL features accommodate the same.
The integrated approach provides the importance of
each method through an overall perception of
prioritisation addressing risk in various
manufacturing activities. The basic tools used for
integration were validated in various studies so that
these methods can be employed as a measure of
discomfort or the risk for WMSDs [24]-[33], [7]. The
results from the application of the methodology
based on basic tools in the industry show the
potential of risk in various body sites as well as with
the body regions in selected jobs.
From the results of discomfort surveys and
postural evaluation, it is seen that shoulder (right)
and lower back are highly potential to risk in Pump
Assembly job. The postural evaluation based on
PLIBEL indicates that incorrect working height,
weight of the load, awkward grasping of load and
handling above shoulder height are reasons for
these discomforts. QEC also supports it by very
frequent shoulder/back movement and work
at/above shoulder height is the reasons for
discomfort. By adjusting work height based on the
stage of the assembly and avoiding the awkward
lifting of assembly will reduce the risk to an extent.
An adjustable worktable is suitable for addressing
the same [29].
In Motor Assembly job, it seen that both knees,
wrist (right) and lower back has potential to risk
based on self-reports. The postural evaluation
back evidently. The postural evaluation based on
PLIBEL indicates that incorrect working height,
similar work movements, forceful and twisting
movements of hand, weight of the load/ material and
handling below knee height are reasons for
discomfort. QEC also supports the discomfort of
wrist with deviated/bend wrist and higher numbers
of similar movement patterns. The risk indices for
the wrist/hand also support the same. The work
place redesign to avoid squatting posture to picking
materials for assembly, increasing work place height
and avoiding the awkward lifting of assembly will
reduce the risk to an extent.
The OD Machining job has got higher potential of
risk at shoulders, wrist and feet. Postural evaluation
based on PLIBEL indicates that bending and flexing
of back, weight of the load, repetitive lifting of load,
awkward location to place the load, visual capacity
reduction due to glare for checking the dimensions
are reasons for discomfort for shoulders.
Uncomfortable carrying, similar work movement
(carriage), twisting and forceful movements are
reasons for discomfort for wrists. Keeping one leg
for supporting body weight and standing work
without the provision of seating are the reasons for
feet discomfort which is only related to the
personnel other than the nature of work. The
frequent movements of shoulder, wrist
bending/twisting and similar movements are
reasons for discomfort for shoulder and wrists based
on postural analysis with QEC. The risk indices for
the included area also support the same. The risks
can be reduced by providing adequate lighting to
avoid unnecessary flexion of back and neck while
doing inspection. The work height is proper for the
work.
For the Stage Casing (Drilling & Tapping) job the
potential discomfort regions include wrist (right) and
hip/buttock. The postural evaluation by PLIBEL
shows that too limited space for movement,
fatiguing movement of foot are reasons for hip/
buttocks discomfort. Repeated pushing and pulling,
twisting, forceful and uncomfortable hand
positioning are reasons for wrist discomfort. The
task with deviated bending of the wrist and keeping
arm above the shoulders are reasons which has
been found from QEC for wrist discomfort related to
the job. The risk indices for the included area also
support the same. The work height adjustment to
avoid flexion of back and neck, redesign of work
place and the pedal work will reduce the potential of
risk in this job.
The prioritisation of risk among selected jobs has
been done based on mean risk indices. The paired
comparison of risk indices also provides the same
priority. The Stage Casing (Drilling & Tapping) job
has got higher mean risk index and Motor Assembly
has got lesser value. The higher discomfort indices
of body regions as well as overall discomfort index
of QEC indicate a higher level of discomfort
potential for all the jobs which are not properly
emphasized on discomfort surveys. It is more
relevant about neck discomfort, which shows the
maximum index of unity for Stage Casing (Drilling &
Tapping) job and provides indices of 0.8889 for
other jobs.
The ANOVA results show that the discomforts
among body sites have significant difference and
the used self-report methods are independent in all
jobs. Also it is seen that the difference in overall risk
indices selected jobs is not significant at 5% level. It
indicates that the selected jobs are belonging to the
same group of criticality and overall risk indices will
help to categorize jobs in SMEs based on risk
potential. But it is evident that all basic methods
other than QEC provide higher risk indices for Stage
Casing (Drilling & Tapping) job. This task has also
got higher exposure to the lower extremities and
QEC does not account for the same. All other jobs
have only lesser exposure to the lower extremities.
It indicates that adaptation of method is very
important for assessing risk of disorders and the
integrated methodology addresses the same.
V. CONCLUSIONS
An integrated methodology has been developed
to assess the risk of musculoskeletal disorders
based on a self-report questionnaire and
observation checklist to cater the needs of SMEs.
The integration of basic methods has been utilised
to develop the questionnaire as well as checklist.
The methodology has been applied to a medium
scale manufacturing industry. Four critical jobs have
been selected from the industry and results show
that Stage Casing (Drilling & Tapping) job has got
highest prevalence of WMSDs. All the selected jobs
having higher potential of discomfort which is not
adequately perceived by the operators through self-
reports. The proper workplace arrangement,
avoiding the heavy manual lifting by the operator,
adequate movement space, avoiding troublesome
visual conditions and ergonomic based training will
reduce and eliminate most of the discomfort
problems in these jobs. The variation of overall risk
indices shows that selected jobs belonging to the
same category of risk. The mean risk index and
paired comparison method have been used for
prioritising the jobs based on criticality. The study
can be extended to the other jobs in order to
develop a risk priority database within the industry
which can be updated with exposure audits based
on the integrated methodology. Also a web based
adaptation of the methodology with standalone
cameras at worksites can provide a fully
computerised WMSD monitoring system.
ACKNOWLEDGEMENT
The authors acknowledge the Department of
Design and Environmental Analysis and Human
Factors and Ergonomics Laboratory at Cornell
University in USA, Health and Safety Executive in
UK and Occupational Health and Safety Council of
Ontario for providing online resources. Also they
acknowledge the management and workers of
Rotating Machinery Division of PSG Industrial
Institute in India for their cooperation and support for
the application of the methodology.
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