Foreword: Prof. Antonio Grieco

FOREWORD
This book is somewhat unusual for several reasons.

First of all, the topics presented in these chapters have never before been dealt with in quite the same
way in any country or in any language: the risks and consequent disorders of the upper limbs associated
with repetitive tasks in a working environment have until now received scant attention, peppered with
the occasional misguided affirmation and often entirely inadequate preventive guidelines.
Secondly, the book was written specifically for "times and methods" experts, i.e. the men and women
who design, implement, inspect, assess and modify the times and methods with which certain tasks are
performed in a manufacturing environment, based on their own professional expertise and experience.
Of course, there is nothing to stop the book being read by consulting physicians, prevention and
protection managers and worker representatives, pursuant to the European Framework Directive n.
391/89: however, they should use it in order to be better equipped to cooperate with the "times and
methods" experts when assessing and preventing work-related risks.
Thirdly, the book is quite unique also insofar as it takes an entirely original approach to the problem:
it passes no judgement on the concept of "repetitive work", "assembly-line work", or on the
"monotony" that may be associated with it, nor on the conceptual framework to which Engineering
personnel make reference when they design manufacturing systems and processes. The authors call
nothing into question" they have adapted comfortably to the situation, and use the same language as
their readers, in order to offer realistic alternatives - with countless real-life examples - as dictated by
the science of ergonomics.
All this makes the manual not just immensely readable, but also a rich source of otherwise hard to
find information that will certainly facilitate the dissemination and practical application of the principles
of ergonomics. In the absence of scientific certainties, the authors rely on their experience and on a
healthy dose of common sense, without ever confusing the two.
Credit must go largely to Daniela Colombini and Enrico Occhipinti, both brilliant former students of
mine and now internationally renowned experts, for their dedication, perseverance and scientific rigor:
they have enriched this field of prevention with new knowledge of inestimable value.
Prof. Antonio Grieco

President, EPM
ACKNOWLEDGEMENTS
I would like to dedicate this volume to the technical teams at Whirlpool Europe, Ceset-
Emerson, Electrolux-Zanussi and Embraco and in particular, to Michele, Nikolay, Sara,
Marco G., Marco P. and Candido.
Without their help and patience in teaching me the language of Work Organisation and by
providing me with excellent results, I would not have been able to prepare this manual, the
aim of which is to teach industrial technicians how to manufacture without provoking illness.
Thanks again to all of you and to other technicians that will continue to help us along the way.
This is only the beginning!
In particular best thanks to Olivetti Tecnost s.p.a (Daniele Gallo and Lorenzo Grippiola) that
developed the software to calculate the Ocra index with the intention of offering free, this
precious and feasible tool of risk analysis and prevention to all company technicians.
The program is available over the Intemet" http://www.elsevier.com/locate/colombini
Daniela Colombini
1. AN I N T R O D U C T I O N TO E R G O N O M I C S AND THE AIM
OF THIS H A N D B O O K
Definition and aims of ergonomics
The term "ergonomics" comes from the Greek "ERGON" (work) and "NOMOS" (law). A word with
similar roots was employed for the first time by Jastrzebowski in 1857, in a Polish paper.
The aim of Ergonomics is that of improving the conditions of working environments and tools, and
also of improving the performance of human operators.
Ergonomics is based on the knowledge and experience collected in the field, and in experimental
studies: as such, it is an innovative tool, which will improve safety, health and the well-being of the
operators.
Ergonomics started with a relatively restrictive conception of the relationship between man and
machine, in 1940; but today it has a much wider approach, dealing with all the physiological,
psychological, technical and organizational issues relating to the interaction between human working
activities and the environment. Modem Ergonomics, which analyzes and designs systems, is defined as
"Macroergonomics" in the USA.
Ergonomics cannot be defined as a science, not even a "new science". It draws inspiration from
various scientific disciplines and fields of knowledge which were already available- its main
characteristic is that it uses them all in an inter-disciplinary way, focussing on its own scientific aims.
From this point of view, ergonomics could be better described as being a technique for analysis,
assessment, design, all absolutely anthropocentric, using scientific knowledge which comes from pre-
existing disciplines. Among these, there are at least 3 fields which supply contributions of primary
importance: technical sciences (engineering, architecture, etc.), bio-medical sciences (anthropometrics,
physiology, hygiene, occupational medicine, etc.), and psycho-social sciences (organizational
knowledge and all the various sociological and psychological branches).
The end target of ergonomics is not only that of preventing accidents and illness, but mainly that of
promoting good health, in the sense of psycho-physical well-being.
It is of fundamental importance to have a systematic approach, and the object of analysis, assessment
and design, simple as it may be, must always be represented with due consideration of all foreseeable
inter-correlations. In fact, ergonomics does not simply mean designing the fight kind of chair, or
whatever other object: it also means considering its global impact with the user/operator, the
environment, and the organization of work.
Ergonomics is characterized by three basic principles"
a) global intent;
b) inter-disciplinary approaches;
c) participation of operators/users.
2 RISK ASSESSMENT AND MANAGEMENT OF REPETITIVE MOVEMENTS AND EXERTIONS OF UPPER LIMBS
Global intentions. By this, we mean adopting as many improvement policies and actions as possible,
for the work place, for the environment, and for the work processes.
Ergonomics is a technique for primary prevention: it is essential to capably assess the risk-generating
conditions so as to prevent damage before it actually takes place. Epidemiology is useful, but it works
along opposite directions, starting from an observation of damage and working back to the definition of
the presence of risks. Many choices of processes can actually already be considered as potential risks
to worker well-being. In fact, a rigid imposition of times, a lack of sufficient information, scarce
physiological recovery periods, and suchlike, must be recognised a priori as being potential risk
generators.
Primary prevention is mainly carried out via good alternate organizational choices when planning a
working process.
Interdisciplinary approach. Pursuing "well-being" within a production process requires that all the
bio-medical, technical (engineering and architecture) and social knowledge be well-integrated- this is
essential to guarantee global effects.
Participation of operators/users. Not only does this participation generate further resources for
planning and design, but it actually makes the ergonomic solutions which are eventually found
applicable.
Fields of application within the european technical regulation
Currently, ergonomics recognises an extremely wide number of fields of application, both in the
working area and outside of the occupational world.
If the focus is narrowed to the occupational area alone, readers must be informed of the fact that a
vast body of technical and practical regulations have emerged, with relation to the design of machines,
and they are being implemented on a European basis (CEN), under the name of Harmonised
Regulations.
Most of them are still in the drafting phase, or in the final approval phase as application standards of
the so-called "Machinery Directive". They concern various different techniques, and suggest methods
useful to define the presence of various risk factors in the field of ergonomics. One entire chapter
(Chapter 15) of this book is in fact devoted to the regulations which are of greatest interest for the
prevention of musculo-skeletal disorders.
The above-mentioned regulations range from a consideration of risks coming from handling
operations, to the limits of exertion, to anthropometric measurements, up to the best ways of designing
tasks, working places, high-frequency tasks, areas and spaces for operator movement, etc.
These harmonised regulations are mainly intended for designers of machinery and for those who
actually plan occupational tasks. Of course, this implies that individuals such as designers of machinery,
production processes, products, and Times and Method analysts, must all have deep and complete
knowledge in the field of ergonomics.
A changing profession: from time and methods analysts to experts in work organization (N.
Murikoff)
Industries are becoming increasingly competitive and companies are being forced to constantly raise
their productivity levels in order to stay competitive: their output needs to be flexible enough to meet
the market's demand for high quality products.
AN I N T R O D U C T I O N TO ERGONOMICS A N D THE AIM OF THIS H A N D BOOK 3
To reach these objectives, companies must first of all leverage the enormous potential that is
represented by their human resources, and involve operators in enhancing performance standards.
Operators can no longer be regarded as a pair of arms: these days their hearts and brains need to be
involved, so that jobs can be created that respect workers and express confidence in their skills.
In the "Factory of the Future" it is necessary to reconcile the need for a pleasant work environment
with the aims of high productivity; in fact, ergonomically satisfactory work stations are becoming a sine
qua non for attaining Productivity, Quality and Flexibility.
This evolution in industrial labour means that the profession of the Time and Methods Analyst must
become broader in its scope and increase the depth of its expertise.
The tasks of the Time and Methods analyst
The primary responsibility of the Time and Methods analyst is to ensure that industrial work is
performed correctly and ergonomically, and that it respects the physical and psychological well-being
of the operators.
The tasks of the Analyst include planning the manufacturing process; organizing the work, work
force and work station; checking and monitoring the efficiency and productivity factors; and steering
the process of continuous improvement.
Another vital responsibility is of course to supply the baseline data (times) that serve for industrial
accounting purposes in order to accurately cost the products.
The Analyst must therefore determine the work method to be adopted and design the work station
according to the criteria of ergonomics and productivity, while also ensuring that the process produces
products to the required standards.
The determination of the work method includes assigning jobs (and therefore determining cycle
times) and studying techniques for performing them; balancing and sequencing work stations; deciding
on pauses and changes.
The design of the work station includes the layout and the structure of the work station and the line;
the tools to be used; organizing the flow and supply of materials (handling); monitoring the various
ambient parameters (lighting, noise, temperature, humidity, harmful substances) around the work station.
The tools used by the analyst must above all facilitate the analysis of less evident risk factors that
may be extremely difficult to detect, but which may nevertheless jeopardize the health and well-being
of the operators. It is extremely important to distinguish between the risk of safety-related accidents,
and the risk of progressive medium- to long-term wear on human health.
Involvement and responsibility: the new frontiers of industrial work
The tools for carrying out risk analysis must provide practical and concrete suggestions on how to avoid
problems arising from the ergonomic viewpoint a priori, so that the analyst is no longer a troubleshooter
but rather a specialist in preventing problems.
The analyst must devise work methods and work stations that right from the very start respect the
fundamental principles of ergonomics, as well as examine and correct work stations that are
ergonomically unsatisfactory.
Both when designing and when redesigning, the involvement of the operators becomes a natural and
necessary process, since the operators know their work station better than anyone else, and it is the
operators who draw immediate benefits from ergonomic improvements.
4 RISK ASSESSMENT AND M A N A G E M E N T OF REPETITIVE MOVEMENTS AND EXERTIONS OF U P P E R LIMBS
The analyst develops close ties with the operators, which should encourage ever greater involvement
on their part. Not only is the analyst an expert in technical and physiological areas, but he or she also
needs to acquire socio/psychological skills and management/organizational abilities.
The aim is to develop industrial work with respect to the ergonomic aspects as well as in other fields
such as quality and productivity, moving from external supervision to self-supervision on the part of the
operators.
The industrial analyst therefore needs to have solid training and field experience, and the fundamental
tools are pre-determined time systems and an in-depth knowledge of ergonomics.
Besides a basic understanding of anatomy, anthropometrics and ergonomics, analysts ought also to
be equipped with the practical tools needed to holistically analyze all the various aspects pertaining to
posture, repetitiveness, force, tools and equipment and environmental factors.
The method proposed in this volume has the advantage of tackling the problem of repetitive upper
limb motions analytically and scientifically: analysts are provided with clear indications of the impact
of individual risk factors and, consequently, equally clear indications of possible ways to improve them.
Contents and scope of the handbook
One of the issues that is emerging as a source of health problems in the work place is the risk
represented by repetitive upper limb motions.
All the foremost international epidemiological studies state with almost univocal certainty that these
motions are the cause of upper limb disorders such as tendinitis and carpal tunnel syndrome.
Moreover, while various highly reliable and complex methods have been proposed to evaluate risk
factors such as posture and force, which both contribute to a biomechanical overload of the upper limbs,
many have the drawback of needing to be carried out in specialized laboratories.
In short, the current literature agrees on defining these disorders as "WORK RELATED", but only
seldom are methods of evaluation and modification offered that can be applied in the field and are able
to assess all the risk factors likely to cause the disorders.
This volume is dedicated in particular to the professionals who are responsible for managing work
organization, designing machinery and equipment, and putting the production process in place.
The risk associated with repetitive movements requires analytical approaches and methods for
processing the results that involve all the principles of a global ergonomic analysis, i.e.:
- it is essential that those who design machines and create tasks/operations be familiar with all known
risks;
- the factory must routinely have on hand a team of experts including time-methods professionals,
process and product engineers, designers, safety experts, occupational doctors and worker
representatives, with the wholehearted support of top management. Their various fields of specific
expertise, in addition to an understanding of the concept of risk and risk analysis methods, represent
tangible evidence of the need for an interdisciplinary and global approach to designing and
redesigning work stations;
- the various individual risk factors which together determine the level of exposure, are analyzed and
rated separately. These may be physical factors (force, posture) or factors more closely associated
with work organization (recovery periods, frequency of action);
- the design and redesign priorities are decided directly by the team of experts (e.g. acceptable risk
thresholds, risk factors to be reduced, etc.).
AN INTRODUCTION TO ERGONOMICS AND THE AIM OF THIS H A N D BOOK 5
With this volume an approach is offered that can be used to make "intelligent decisions" in light of
the resulting cost/benefit considerations.
In short, this volume not only offers an analytical method that can be applied in the field of emerging
work risks (awareness of the problem), but also an opportunity for self-management aimed at generating
intelligent decisions.
It is also important to stress that the analytical methods and operative strategies presented here have
been tested, validated and discussed with members of the technical staff of numerous important
industries during the course of on-site research into the relevant issues.
The valuable cooperation, suggestions and additions concerning the need to bring industry closer to
the world of research have produced a significant example of how a new subject can generate methods
of analysis devised by expert researchers but implemented and immediately validated in the field,
thanks to close cooperation with technical personnel on the factory floor. They have been acknowledged
as the co-authors of this book, not as a mere formality, but because their inclusion reflects a deliberate
operative strategy: to create methods of analysis in conjunction with technical personnel and for
technical personnel.
2. M U S C U L O S K E L E T A L DISEASES DUE TO BIOMECHANICAL
OVERLOAD
Introduction
The onset of organized work, both in the manufacturing and services industry, together with the growing
average age of the European working population, have led to a change in occupational health hazards.
A clinical assessment of the relationship between work and the most common chronic-degenerative
pathologies was carried out both by groups of experts and by single researchers: they ascribed a
significant part of cardiovascular events, respiratory diseases, and musculoskeletal disorders afflicting
the general population to occupational causes.
A sample survey carried out in 1996 by the European Foundation of Dublin on the general health and
occupational conditions of European workers has shown that the most commonly reported health
disorders are backache (30%), stress (28%), and muscular limb pains (17%).
33% of the workers have stated that they are employed in the usual fashion in jobs requiting repetitive
movements of the upper limbs. The repetitive work is joined to intense working rhythms in 49% of the
cases reported.
The pathologies discussed here, among all those most frequently related to occupational causes, will
be those referring to the upper limbs. The authors will attempt to point out the strength of their
correlation with the occupational causes.
In 1700, B. Ramazzini described disorders caused by violent, irregular movements, and by
incongruous postures. He indicated the efforts of the hands and arms of the scribes as cause of
functional deficits of the fight hand.
At the end of 1900, the same disorders were also found in shoemakers, tailors and milkmaids.
Occupational pathologies induced by repetitive movements are the highest cause of musculoskeletal
and peripheral nervous lesions in the working population, higher than accident-induced traumas. This
is in contrast with the conclusions drawn by the "International Conference on Machine Pacing and
Occupational Stress", held in 1981 at Purdue University. The consensus had then been the forecast of a
remarkable decrease of jobs requiting repetitive movements, and a consequent reduction of negative
effects on the operators, including musculoskeletal disorders of the upper limbs.
This forecast turned out to be mistaken - in fact, occupational illnesses of the upper limbs have
constantly increased from 1982 to 1994: in 1990 the so called Cumulative Trauma Disorders
represented well over 60% of all occupational s in the USA.
It may be stated that musculoskeletal occupational illnesses are diseases like any other, because they
have a natural history and a treatment. Still, because they are described as "occupational", or "work-
related", they can give rise to claims for damages if the actual occupational origin is ascertained.
D e f i n i t i o n s
Occupational musculoskeletal pathologies of the upper limbs can be defined as an alteration of the
muscle-tendon units, of the peripheral nerves, and of the vascular system. Their onset may be
precipitated, or they may be enhanced, by movements, and/or by repetitive physical efforts of the upper
limb.
Many acronyms are employed in international literature to describe musculoskeletal disorders, and
to indicate their occupational origin. Table 2.1 shows the most commonly used definitions. According
to Hagberg et al. (1995), the term "Work related MusculoSkeletal Disorders" (WMSDs) is most
appropriate, because it postulates that there is an occupatonal cause in the onset of these pathologies,
and because the term does not include the postulated cause ("cumulative" for CTD, and "repetitive" for
RSI) or the effects.
This term therefore groups various pathological entities which may involve the various structures of
the musculo-skeletal system: all of them have in common the possible occupational aetiology, as a
consequence of repetitive and/or cumulative traumas.
Table 2.2 shows the most important and frequent work-related musculoskeletal disorders of the upper
limbs.
Evidence o f the association between upper limb diseases and working condition. In "specific
occupational diseases" a direct cause-effect relationship can be found between a noxious occupational
agent and the disease. Conversely, "work-related diseases" are described by WHO experts as being
multifactorial.
Epidemiological data concerning the scope of the relationship between muscoloskeletal pathologies
and occupation is as yet not fully available in a homogeneous format. For reporting reasons, the
Table 2.1 - Main acronyms used
Acronyms
WMSD Work related Musculo Skeletal Disorders

CTD Cumulative Trauma Disorder
RSI Repetitive Strain Injury
OCD Occupational Cervico-brachial Disease
OOS Occupational Overuse Syndrome
Table 2.2 - Musculoskeletal disorders of the upper limbs most frequently related to working conditions
- Shoulder tendinitis or scapulo-humeral periarthritis

- Lateral and medial epicondylitis
- Hand/wrist tendinitis, De Quervain's Syndrome, trigger finger
- Carpal tunnel syndrome, Guyon's canal syndrome, other canalicular syndromes
- Bursitis (various joints)
- Tendon cyst
- Metacarpal-phalangeal arthrosis
M U S C U L O S K E L E T A L DISEASES DUE TO B I O M E C H A N I C A L O V E R L O A D 9
authors have compared the results obtained in the various studies, with discrimination according to
protocol and to specific jobs studied. It was then possible to point out the degree and consistency of
the relationship between the single pathologies most commonly concerning the upper limbs and
occupation. A priceless reference is Hagberg et al's paper (1995), whose critical assessment of
literature on this issue was carried out according to strict study quality selection criteria proving that
such associations existed.
Shoulder tendinitis. The term "shoulder tendinitis" also includes all forms of peritendinitis,
tenosynovitis and myotendinitis; clinically, these are not easily distinguishable from each other.
The main symptoms are pain associated with movement during the initial phase, and irradiated pains,
even during the night, with a reduction of motor function during the advanced phases.
The epidemiological studies presented in Table 2.3 are mainly characterised by a cross-sectional
study design; a high prevalence of this type of pathology was proven in worker groups such as welders,
industrial assembly workers, packaging unit operators, workers exposed to high repetitive rhythms and
with the need to apply great strength, and workers who must keep their hands at shoulder height. The
association was very strong in all the studies carried out, and this proved that the effects were not casual.
The fact that these studies were repeatable in different industrial sectors, characterised by repetitive
jobs with the upper limbs raised at shoulder height, has proven to be a positive point, because a
significant correlation with occupation was found. In fact, in jobs implying the lifting of the upper limbs
to shoulder height, the shoulder tendons are submitted to static compressions and tensions which
compromise blood circulation, thereby speeding up the degenerative process.
Lateral epicondylitis. The main symptoms are the onset of a point-like pain, laterally with respect to the
elbow: the pain gets worse with movements of the elbow and wrist, and tends to irradiate along the
forearm.
The epidemiological studies presented in Table 2.4 have shown a weak association with occupation
among groups or workers employed in butcheries, meat cutters, sausage factory operators, packagers,
Table 2.3 - Shoulder tendinitis. A comparison between study design and job requirements
Type of study Effect measurements Bibliography
Cross-sectional
Welding of hulls OR 13-11" Herberts '81-84
Industry - Jobs implying the use OR 5.4* Silverstein '85
of strength and repetitiveness
Packaging OR 2.6 Luopajarvi '79
Packaging OR 2.4 McCormack '90
Hosiery OR 2.1 McCormack '90
Cleaners OR 1.9 McCormack '90
Data input OR 0.54 Kukkonen '83
Case controls
Industry - Jobs with hands OR 11" Bjelle '79
above shoulder level
* p<O.05
IO RISK ASSESSMENT A N D M A N A G E M E N T OF REPETITIVE MOVEMENTS AND EXERTIONS OF UPPER LIMBS
Table 2.4 - Lateral epicondylitis A comparison by study design and job
Cohort
Sausage factory RR 1 0.3 n.v. Kurppa '91
Meat processing RR 7.1 n.v. Kurppa '91
Packaging RR 6.4 Kurppa '91
Cross-sectional
Meat processing OR 6.9 Roto '84
Packaging OR 1.5 McCormack '90
Hosiery OR 1.5 McCormack '90
Cleaning, maintenance services OR 1.4 McCormack '90
Meat processing OR 1.2 Vikari-Junt. '91
Packaging OR 1.2 Luopajarvii '79
Mechanical industry OR 0.7 Dimberg '87
n.v. = significance not assessed
tailors. The only cohort study carried out on sausage factory workers, butchers and packagers has shown
a high degree of correlation with occupation.
As for the pathogenesis of lateral epicondylitis, the leading hypothesis is that micro-breaks in the
fibres, at the insertion point between the tendon and the periosteum, may trigger an inflammatory
process which, in turn, could result in fibrosis. Most probably, repetitive jobs requiting a great use of
strength or brusque movements can engender the disorders described above.
Hand~wrist tendinitis. Hand/wrist tendinitis concems the tendons crossing the radiocarpal joint. The
most commonly observed form is De Quervain's tendinitis (or Syndrome), which is an inflammatory
form of the tendons of the long abductor muscle and of the short extensor muscle of the thumb.
Available epidemiological studies (Table 2.5) show that there is a high risk of this pathology in the
manufacturing industry in general, and in meat processing plants - this points to a high degree of
association between the pathologies themselves and the specific occupational exposure situations.
The pathology's repeatability has been proven, and so has the correlation between the incidence of
tendinitis and work seniority, number of objects handled on the job, high repetitiveness of the gestures
required, and degree of strength applied.
Because the area where dorsal hand and wrist tendons pass is so small, repetitive activities can
engender tendon inflammation as a reaction.
Carpal tunnel syndrome. Compression of the median nerve at the carpal tunnel leads to the onset of both
sensory and motor disorders in the corresponding area of innervation, such as, i.e., typical nocturnal
paresthesiae (tingling, loss of sensitivity, etc.), whose effect is such as to disturb sleep. This can be
shown quite accurately with electrodiagnostic testing.
Various epidemiological studies (Table 2.6), both cross-sectional and case-control, have highlighted
a prevalence of cases in various jobs requiting repetitive movements and the application of a high degree
of strength with the upper limb.
M U S C U L O S K E L E T A L DISEASES DUE TO B I O M E C H A N I C A L O V E R L O A D I I
Table 2.5 - Hand~wrist tendinitis. A comparison by study design and job
Cohort
Sausage factory RR 24 n.v. Kurppa '91
Meat processing RR 14 n.v. Kurppa '91
Packaging RR 36 n.v. Kurppa '91
Cross-sectional
Industry- Jobs implying strength OR 29 n.v. Silverstein '85
and repetitiveness
Industry - Strength alone OR 6.1 n.v. Silverstein '85
Industry - Repetitiveness alone OR 3.3 n.v. Silverstein '85
Packaging OR 7.1" Luopajarvi '79
Kitchen workers OR 8* McCormack '90
Hosiery OR 5.4* McCormack '90
Packagaing OR 3.9* McCormack '90
Scissors manufacturing OR 1.4 Kuorinka '79
n.v. = significance not assessed;

* p<0.05
Table 2.6- Carpal tunnel syndrome. A comparison by study design and job
Cohort
1.300.000 Washington Incid. 2%
Packaging oysters and crustaceans RR 14.8" Franklin '91
Meat processing RR 13.8* Franklin '91
Packaging RR 36 n.v. Kurppa '91
Case-control
Wrist flexion jobs 20-40 OR 8.7* De Krom '90
Wrist extension jobs, hours/week OR 5.4* De Krom '90
Vibrating tools,exposure >20 years OR 4.8* Wieslander '89
Repetitive jobs, exposure >20 years OR 4.6* Wieslander '89
Cross-sectional
Industry - High force and OR 15.5'** Silverstein '85
repetitiveness
Industry - Repetitiveness only OR 5.5* Silverstein '85
Ski manufacturing OR 4.0* Barnhart '91
Deep-frozen f o o d - OR 9.4* Chiang '90
Repetitiveness plus cold
Deep-frozen f o o d - OR 2.2* Chiang '90
Repetitiveness only
n.v. = significance not assessed;

* p<0.05; ** p<0.01
12 RISK ASSESSMENT A N D M A N A G E M E N T OF REPETITIVE M O V E M E N T S AND EXERTIONS OF U P P E R LIMBS
Incidence (three times greater in women with respect to men) varies according to the type of job,
from 0.20 cases per 100 workers/year, up to 61 cases per 100 workers/year in specific activities" this is
to be compared to 0.1 cases per 100 people/year in the general population.
A strong correlation has therefore been proven between repetitive jobs which require the use of high
strength, and the onset of the carpal tunnel syndrome.
It has furthermore been proven that extreme postures of the wrist joint (either repetitive or prolonged)
increase pressure within the carpal tunnel, leading to nocturnal paresthesiae due to compression.
Although various systemic disorders may actually be correlated to the onset of the carpal tunnel
syndrome (diabetes mellitus, rheumatoid arthritis, mixoedema, amyloidosis, hypothyroidism, obesity,
pregnancy, menopause, oral contraceptive use), its occupational etiopathogenesis is consistent with
current scientific knowledge.
Thoracic outlet syndrome. Symptoms and signs related to this syndrome are not characteristic: in fact,
diagnosis is often made by exclusion. Upper limb disorders are generally present in variable
combinations, i.e., nocturnal and diurnal paresthesiae, pain, upper limbs that tire easily.
Only a few studies are available in which the prevalence of the syndrome has been definitely
correlated to occupational causes (Table 2.7). The lack of universally recognised diagnostic criteria
probably justifies the paucity of studies. Moreover, in the available ones, the correlation was weak, and
correlation repeatability was contradictory.
However, it has been experimentally proven that the increased pressure of the muscles leads to
compression of the brachial plexus, and hence to the onset of the syndrome symptoms.
Manual jobs and repetitive upper limb movements, especially with the limbs upraised, can therefore
be correlated to the onset of the syndrome. It is however probable that the syndrome occurs mainly in
workers with constitutional defects. The occupational etiopathogenesis of the syndrome is consistent
with current scientific knowledge.
Cervical radiculopathy and tension neck syndrome. Available studies on cervical radiculopathy have not
documented any correlation with occupational causes. It should still be pointed out that these studies
Table 2.7- Thoracic outlet syndrome, tension neck syndrome. A comparison by study design and job requirements
Thoracic outlet syndrome

Cross-sectional Prev 0.5%
Vibrating tools OR 4.0* Hagberg '87
Assembly OR 1.4 Toomingas '91
Industry - Repetitiveness OR 1.0 Luopajarvi '79
Tension neck syndrome

Cross-sectional
Industry - Strength and repetitiveness OR 5.9* Silverstein '85
Foot wear manufacturing OR 7.3* Amano '88
Data input OR 4.9* Hunting '81
Scissors manufacturing OR 4.1" Kuorinka '79
* p<0.05
MUSCULOSKELETAL DISEASES DUE TO BIOMECHANICAL OVERLOAD 13
have turned out to be very low power: it is therefore not possible to exclude such an association with
any degree of certainty.
Conversely, the tens neck syndrome (an epidemiological term indicating the presence of muscle pain
in the neck and shoulder area) turned out to be clearly correlated with occupational causes in various
studies (Table 2.7), and specifically when static positions of the neck are kept for a long time, such as,
i.e., typists or computer operators.
The correlation turned out to be modest for specific jobs. As yet, the etiopathogenesis has not been
explained clearly, but various causes are postulated: these could be triggered by prolonged static muscle
contractions, especially of the upper trapezius muscle. Correlation with occupational causes is therefore
consistent with current scientific knowledge.
W M S D prevalence data over an italian reference sample
A total number of 749 workers involved in jobs that do not constitute a risk for musculoskeletal
disorders (WMSDs) were submitted to clinical tests using a standardised method. The age gender
subdivision was as follows: the males were 139 between 15 and 35 years old, and 171 above 35; the
females 176 between 15 and 35 years, and 263 above 35 years.
"Anamnestic" cases were defined according to the presence of pain and or paresthesiae for at least 1
week over the previous 12 months or present at least once a month, and not a consequence of acute
traumas. The prevalence of anamnestic cases was 4.4% among the males (15-35 years old) and 12.3%
(>35 years old); 4.6% among the females (15-35 years old) and 14.2% (>35 years old).
Table 2.8 shows the prevalence of the pathologies, which were calculated over a total of 1498 limbs
examined in 749 workers constituing our sample: suspect thoracic outlet syndrome: 0.3 % among males
>35 years of age; 0.6% among females aged 15-35; 1% among females aged >35; scapulo-humeral
periarthritis: 0.3% among males aged >35; 0.3% among females aged 15-35, 1.3% among females
Table 2.8 - Prevalence of upper limb disorders, by age group and gender. The prevalence of the disorders is
calculated on the overall number of limbs examined, which is equal to the number of individuals multiplied by two
Males Females
Age group 15-35 >35 15-35 >35
Diagnosis N % N % N % N %
Suspect thoracic outlet syndrome 0 1 0.3 2 0.6 5 1

Scapulo-humeral periarthritis 0 1 0.3 1 0.3 7 1.3
Lateral epicondylitis 0 1 0.3 0 1 0.2
Trapezoid-metacarpal arthrosis 0 0 0 4 0.8
Hand/wrist tendinitis 0 3 0.9 3 0.9 0
Carpal tunnel syndrome 0 0 0 13 2.5
Total WMSDs
(by gender and age group) 0 6 1.8 6 1.7 30 5.7
Total WMSDs
(by gender) 1% 36 4.1%
Individuals examined 139 171 176 263
14 RISK ASSESSMENT A N D M A N A G E M E N T OF REPETITIVE MOVEMENTS AND EXERTIONS OF UPPER LIMBS
Table 2.9 - Prevalence of affected individuals, by pathology, gender and age group
Males Females
Age group 15-35 >35 15-35 >35
Pathologies N % N % N % N %
Suspect thoracic outlet syndrome 0 1 0.6 2 0.6 5 1.9

Scapulo-humeral periarthritis 0 1 0.6 1 0.6 7 2.7
Lateral epicondylitis 0 1 0.6 0 1 0.4
Trapezoid-metacarpal arthrosis 0 0 0 2 0.8
Hand/wrist tendinitis 0 3 1.8 2 1.2 0
Carpal tunnel syndrome 0 0 0 8 3.0
Total WMSDs
By age group 0 3.6 2.4 7.2
Total WMSDs 3.9
>35; lateral epicondylitis: 0.3% among males aged >35; 0.2% among females aged >35; trapezoid-
metacarpal arthrosis: 0.8% among females aged >35; hand~wrist tendinitis: 0.9% among males aged
>35, 0.9% among females aged 15-35; carpal tunnel syndrome: 2.5% among females aged >35. No
pathologies were found in the age groups not mentioned above. Some individuals had concurrent
pathologies.
The prevalence of individuals affected by at least 1 WMSD is shown in Table 2.9, and is the
following: males: 0% aged 15-35; 3.6% >35; females: 2.4% 15-35, 7.2% >35; these figures represent
3.9% of the total group examined.
The overall picture emerging from the study certainly requires further confirmation, possibly via an
increase of the sample number; but it already indicates that prevalence of the disorders analyzed is very
low among those workers who are not exposed to jobs requiring repetitive movements of the upper
limbs, particularly among the younger age group.
The age-linked increase in prevalence is in accordance with evidence found in literature, and is
certainly one of the main factors contributing to confuse results in epidemiological studies.
As for the influence played by gender, the only detailed data available in literature concerns the
carpal tunnel syndrome. The male-to-female ratio is 1:3 in the general population, but there is no
evidence pointing to a greater sensitivity of females given equal occupational risk conditions. In fact, if
exposure to risk factors is identical, there are no gender-related differences whatsoever.
Considering the low prevalence of WMSDs among the non-exposed population it must be pointed
out that, when these pathologies are present in the working population, the situation must always be
assessed very carefully, because specific risk factors could be present.
Pathogenesis of WMSDs tissue alterations
The pathogenesis of WMSDs involves both mechanical and physiological processes. Mechanical
processes stem from the application of force, and from tiring of the tissues as a consequence of the
application of force, or, more generally, of mechanical stresses.
Tissue alterations can, in turn, interfere with the basic physiological processes and lead to
biomechanical activity alterations or impediments. WMSDs must always be viewed as conditions where
the activity under examination leads to mechanical or physiological disturbances, which then make
themselves obvious with more or less persistent clinical signs and symptoms.
When the activities examined are occupational by nature, the disorders themselves will be defined as
being "work-related".
A basic research postulate is that these alterations also develop when recovery times, allowed
between successive operations or job, are of insufficient duration.
WMSDs are multi-factorial: in fact, the cause of these musculoskeletal disorders can be due to more
than one factor. The factors may be work-related, or be of an individual nature (proportionally, work-
related factors are more than the individual ones). Table 2.10 offers a non-exhaustive list of the main
occupational and non-occupational factors which are considered to be causes of the etiopathogenesis of
upper limbs WMSDs.
These alterations generally develop over time frames that may last weeks, months, or even years: no
incontrovertible data is as yet available on development and onset t i m e s - it may be stated that they are
not the result of a single movement or sudden event.
Repeated conditions of excessive use will lead to an inflammation of the tissues, and that is often the
main event leading to chronic alterations.
Alterations of the tendons, ligaments, and tendon bursae. The movements of the upper limbs and hands
are caused and constrined, among the others by tendons and ligaments on the three main joints: the
wrist, the elbow, and the shoulder. The grouping of these structures constitutes a flexible unit, enabling
a vast range of movements, exceptional force, and also small, delicate and precise handling operations.
This unit is so strong that in some cases it can even damage itself. Generally, muscles are not directly
inserted into the bones themselves: the connection is obtained via the tendons, which can be compared
to stiff cords. Tendons are not elastic and do not contract - they simply transfer force and movement
from the muscle to the bone.
Table 2.10 - A non-exhaustive list of the main occupational and non-occupational factors involved in upper limbs
WMSDs etiopathogenesis
Causing factors (non-exhaustive list)

Work-related Not work-related
Repetitive movements Gender

High frequency and speed Age
Use of force Traumas and fractures
Awkward postures Chronic pathologies
Compression of anatomical structures Hormonal condition
Insufficient recovery Leisure activities
Vibrations Anthropometric structure
Tool dysergonomy Psychological condition
Use of unfit gloves
Exposure to cold
Piecework
Splitting up of jobs
Lack of working experience
The hand and wrist tendons are surrounded by sheaths containing a lubricating liquid, called synovial
fluid. Tendons slip, slide up and down along the sheath every time the related muscles contract and
relax. In the case of overuse of the muscles, the synovial fluid in the tendon sheath may become
insufficient, thereby causing friction between the tendons and the sheath itself. The area where the
tendons are becomes hot, painful and increasingly sensitive: these are all signs of a growing
inflammation (Table 2. l l).
Table 2.11 - Pathogenesis o f tendon and nerve disorders
Highmovementspeed J
Force |
Awkwardpostures J
Hypermobilearea Tendoncompression
Stiff canalin with slidingbetween betweenpowerful
hypermobilearea tendonsandtendon musclesandtight
sheaths
,,,
bonearea
Reductionof lubrifying
liquidin tendonsheath I-High movementfrequency1
becauseof highfriction L_ ~1iagdhe~rcatrec~
ee timesI
betweentendonsand
sheaths
Inflammationand , ~
swellingof tendonsand Localizedcompressions
tendonsheaths
arrow
traumacarpaltunnel 1
Iibonestructure
metabolism
pregnancy JPressureincrease
"-J betweenstiff
~J tunnelwalls
Frictionbetween
tendonsand
sheaths
i Extremejoint postures1
and/ormovements
Formationof
foreignfibrous
tissuebetween
tendonsand
sheaths
, e eent
(of mediaEnge:rve= CTS /
\of ulnarnerve= Guyon's/
Tissue congestion (swelling) can also cause nerve compression: in this case, the individual affected
will have pain and paresthesiae. Normal joint movement can be reduced because of increased muscular
tension. Moreover, if acute inflammation episodes repeat themselves, they can give rise to the formation
of fibrous tissue (adhesions), which is basically responsible for the onset and stabilization of a chronic
pathological condition.
Ligaments are strong elastic "ropes", connecting one bone to the next, to make a joint. When a joint
is subjected to excess use, that is, beyond what is considered as the normal range, some fibres of the
ligament can tear and therefore no longer be connected with the bone: a repetition of such incidents will
lead to permanent instability of the joint, further increasing the risk of more lesions.
Whenever a ligament is subjected to friction, there is a specific lubrication system called "bursa"
which stops the ligament itself from actually rubbing against the bone.
The "tendon bursa" is a small sac full of liquid, wrapped in a synovial membrane. Tendon bursae are
found in those areas of the body which are subjected to repeated pressures during movement, i.e., the
shoulders, elbows, knees: In these areas, the tendons are protected by their tendon sheaths, but also by
these "bursae", which act more or less like a cushion, to reduce friction between the mobile parts. If a
tendon becomes rough because of excess or chronic use, it will also inflame the adjacent bursa, giving
rise to a condition which is called "bursitis"- it is a similar process to that occurring between the tendon
and the tendon sheath. Bursitis reduces the freedom of movement of a tendon, for instance in the
scapular girdle, which is already overcrowded and consequently limits shoulder mobility.
The carpal tunnel syndrome and other entrapment syndromes. The flexor tendons of the hand pass
through a stiff tunnel, 2 to 3 cm long, which is called the carpal tunnel. The walls of this passage are
formed by the arc of the carpal bones; the roof is a stiff ligament wrapping the wrist bones all-round,
the carpal ligament.
Below the carpal ligament, the following pass through the carpal tunnel: the tendons of the finger
flexors, the median nerve, blood vessels; they all connect the hand to the arm.
Median nerve compression may be caused by chronic irritation and consequent swelling
(tenosynovitis) of the long flexors of the fingers within the wrist structure.
The causes responsible for the onset of carpal tunnel syndrome (CTS) may be various different types
of positons and movements of the wrists, and different ways in which the hands grip objects. In tasks
combining a high exertion of force and high frequency of action with repetitiveness, the risk is
enormously increased.
In some types of WMSDs, there is an involvement of both nerves and adjacent blood vessels in the
compression. One of the most common conditions of this kind is the thoracic outlet syndrome, which
involves the shoulder and the upper limb. In this case, compression of the nerves and of the blood
vessels occurs between neck and shoulders.
Table 2.11 summarises the possible etiopathogenic causes associated with functional over-use
conditions for the main disorders of the upper limbs.
3. ESTABLISHING THE PRESENCE OF RISK AND THE SUBSEQUENT
MEANS O F I N T E R V E N T I O N
Various different analytical tools and solutions are suggested for use within a real-life factory, to detect
and quantify the presence of risk connected to repetitive upper limb movements.
OCRA Risk Index
The first analytical procedure is also the most complex and exhaustive one. It involves calculation of
the exposure index by using the OCRA (OCcupational Repetitive Actions) analytical model, which
gives the following results"
- accurate operator exposure levels;

- precise information on which factors influence the index results (an essential process for preliminary
re-engineering studies);
- accurate information for supplying correct design criteria;
- accurate indications for re-allocating individuals with upper limb WSMDs back into their work
environment;
- forecasts concerning the incidence of new upper limb WSMDs cases according to OCRA indices found.
Employment of the OCRA method requires previous in-depth training, preferably carried out by
personnel which are already accustomed to the analysis of jobs and job organization. A really complete
exploitation of the possibilities offered by the OCRA method requires previous organization of an ad-
hoc interdisciplinary group of individuals in the company/factory itself. This group must constantly deal
with all issues relating to the subject, and should include the following professionals: a technician for
the analysis of times and methods; a plant and line designer; an OSH technician (Occupational Safety
and Healt). It would be best if the foreman, or department head, of the specific department being
analyzed at the time, also took part in the meetings and discussions. Time requirements for an analysis
with OCRA method are comparable to those necessary for a regular times and methods analysis. For
example, the analysis of a repetitive task with 30 second cycle may require about 2-3 hours, including
the filming part.
Checklist
The second risk detection tool which will be described here (Chapter 12) is the check-list. It is a quicker
and simpler analytical tool, but as a consequence of this, it is also less accurate than the previous one.
20 RISK ASSESSMENT AND M A N A G E M E N T OF REPETITIVE MOVEMENTS AND EXERTIONS OF UPPER LIMBS
It cannot be considered as a valid alternative to the OCRA index but rather as a flexible and inexpensive
screening tool, useful to find out whether the problem exists in a company and what extent. Drafting of
the check-list takes 10 to 30 minutes per workplace. It is of paramount importance that the check-list is
drafted only by personnel with previous training in use of the OCRA method: the more trained the
personnel drafting the list is, the more reliable the results.
Table 3.1 outlines the procedure for the detection of risk from repetitive movements within a
company, presupposing the presence of an occupational doctor with awareness of work-related upper
limb disorders existing in that company.
It may be useful for the occupational doctor to carry out a "census", initially with anamnestic
screening tools and successively with clinical procedures to screen the WMSDs cases at work-places
characterized by repetitive movements. The prevalences obtained should be compared to those of
reference population samples unexposed to repetitive movements. The results will supply cogent
information on the entity of the problem in the company as a whole and by department/area.
The company's technical staff should be selected and trained to tackle the risk assessment. This will
put them in a suitable position to screen all workplaces characterized by repetitive movements (work
organized in cycles) by using the check-list. It will only take a relatively short time to obtain valid
information, enabling a classification of jobs and workplaces according to "absent risk", "probable
risk", "present risk", "high risk", and actual risk proportions.
This type of analysis then makes it possible to plan suitable actions and the necessary investment of
resources.
Those workplaces which turn out to be at high risk must be submitted to further examination with
the OCRA method, for future re-designing.
Table 3.1 - Procedure protocol f o r the detection of the risk connected to repetitive movement in a company with
an occupational doctor
Spontaneous cases concerning individuals with WMSDs Company occupational Census, via anamnestic interview and
consequent specialistic visits of all cases with
registered by company health service doctor
WMSDs present in the company
Company technical team
Study of the risk~damage relationship for individuals who

are already bearers of WMSDs so as to signal them to the Census of risk due to repetitive movements:
occupational authorities: - check list on all workplaces with repetitive tasks
9 calculation of the O C R A INDICES or check list scores - classification of work-places according to risk level
for current workplace and to risk percentage as follows:
9 calculation of check list scores for previous positions 9 risk absent (%)
in the same company, over the past 10-15 years; if 9 risk doubtful or possible (%)
possible, estimation of exposure for any repetitive 9 risk present (%)
tasks in others companies where employed previously 9 risk high (%)
(if within 10 years of overall professional seniority)
Census and analysis of work-places where risk is absent

Study with the use of the ocra method starting from the
or low for possible re-insertion of individuals with
limited fitness for job highest risk work-places, for redesigning aims
ESTABLISHING THE PRESENCE OF RISK AND THE SUBSEQUENT MEANS OF INTERVENTION 21
Table 3.2- Possible risk signals
- Jobs organized in cycles lasting up to 15 seconds, for at least 4 hours overall within a shift, and requiring the
use of the upper limbs
- Jobs organized in cycles, independently of duration, lasting roughly all the shift, and requiring use of the upper
limbs
- Jobs requiting the repetitive use of force (at least once every 5 minutes), such as: the handling of objects
weighing more than 2.5 kg; the handling, between thumb and forefinger, of objects weighing over 900 g; the
use of tools requiring the application of force
- Jobs requiring the repetitive presence of extreme postures or movements of the upper limbs, such as, i.e.:
uplifted arms, deviated wrist, or rapid movements, or actions requiring striking movements (such as using the
hand as a tool)
- Jobs requiring the prolonged use of vibrating tools (i.e.: pneumatic drills, etc.)
Even for those workplaces where risk assessed was "low" or "absent", a more detailed analysis is
required: in fact, this will make it possible to bring individuals with upper limb pathologies back into
their work environment.
Individuals with known WMSDs must be subjected to a study of the risk/damage ratio; this can be
done by calculating the OCRA index or check list score of their current job, and, wherever possible, of
previous ones too, within the company where they are currently employed and going back for up to 10
years. In some cases, it may also be useful to estimate exposure to repetitive movements even for jobs
carried out by those same individuals in other companies, but always within a 10-year time frame.
The risk/damage ratio study will enable the occupational company doctor to inform the occupational
Authorities that there is a suspect/certain case of occupational disease.
At last, if no OSH professionals are available at the factory level, it is possible to detect the risk of
work-related bio-mechanical overload of the upper limbs by checking on the presence of one or more
of the "risk signals" indicated in Table 3.2. This can be done by the employer, by technical personnel
(un- trained), or by the worker representatives themselves.
Even workplaces with evidence of only one of the characteristics indicated in the Table 3.2, must be
submitted to the first analysis with the check-list. If the workplaces turn out to be at risk, then the
company could supply an occupational doctor.
4. THE GENERAL MODEL OF EXPOSURE ANALYSIS:
RELEVANT DEFINITIONS AND THEIR INTERACTION
WITH JOB ANALYSIS USING THE METHODS-TIME MEASUREMENT
(MTM) SYSTEM
The general model for exposure analysis and related definitions
In consideration of the trends of qualified literature on the subject, it may be stated that in the
description and assessment of work which implies potential bio-mechanical overload due to repeated
movements and/or exertion of the upper limbs, the following main risk factors must be identified and
quantified. When considered together, they characterize occupational exposure with relationship to
actual duration:
a) high action frequency (repetitiveness 1);

b) excess use of force;
c) awkward or stereotyped postures and/or movements of the upper limbs (repetitiveness 2);
d) lack of adequate recovery periods.
Add to these, other "additional" factors that can be considered as amplifiers of risk.
The study of work with repetitive movements of the upper limbs must be performed considering
issues concerning single gestures; it will therefore have to be extremely detailed on the one hand, while
on the other it will have to be capable of summarising within a "whole" vision of the job or task, all the
data originating from the detailed analysis. For such a study, please refer to the definitions in Table 4.1,
which concern both the variables of organized work and the main risk factors considered.
The analytical procedure which is suggested here is organized into the following general points:
- establishing the characteristic tasks of a job, and - among them - those which occur for significant
lengths of time in repetitive cycles, each one equal to the other;
- within the cycles which are representative of each task, establishing the sequence of the technical
actions;
- within each representative cycle, describing and quantifying the following risk factors: frequency,
force, posture, additional;
- re-composition of the data concerning the cycles, as related to the tasks and to the whole working
shift, and in consideration of the duration and sequences of the different tasks and of the recovery
periods;
- a summary assessment of the risk factors for the whole job.
Table 4.1 - Definition of the principle terms used in exposure evaluation
Organized work: an organized set of work activities carried out during a shift or work period; consisting of one
or more tasks.
Task: a specific work activity carried out for the purpose of achieving a specific result (e.g. stitching a part of a
garment, loading/unloading a pallet, etc.).
Tasks may be:
- repetitive: characterized by cycles involving upper limb actions;
- non repetitive: characterized by the presence of non-cyclic upper limb actions.
Cycle: a sequence of relatively short upper limb technical actions repeated several times in precisely the same way.
Technical action: an action involving upper limb activity; not necessarily corresponding to an individual joint
motion, but rather to a set of motions involving one or more body segments, to enable the operation to be
completed.
Risk factors
Repetitiveness: identical events (cycles, postures) that are repeated during a given period of time.
Frequency: number of technical actions per unit of time (no. of actions per minute).
Force: physical exertion required of the worker to perform technical actions.
Posture: the set of postures and motions utilized by each principal upper limb joint to perform a sequence of
technical actions making up a cycle. The risk factor is given by the presence of awkward postures and/or
stereotyped motions.
Recovery periods: periods of time during the shift in which no technical actions are performed by the upper
limbs. Comprising: pauses after a period of upper limb actions during which the muscle metabolism can re-
normalize. The risk factor is given by the lack or inadequate duration of the recovery period.
Additional risk factors: factors not necessarily present in repetitive tasks. Their type, intensity and duration
determines the increase in the overall level of exposure.
The MTM system and its interaction with an analysis of biomechanical overload risks (M. Fanti,
N. Murikoff)
The M T M (Methods-Time Measurement) approach aims to determine the time required to carry out any
manual operation. The analysis procedure breaks down the operation into the elementary motions
required to perform it and assigns a standard predetermined time to each motion, i.e. a time value based
on the nature o f the motion and the conditions under which it is performed.
The M T M analysis is therefore based on a detailed study/plan of the work method in which the
duration of the operation is pre-determined once the method has been defined" thus the time is a
function of the method and not vice versa.
One of the most obvious advantages of the MTM system is that the procedure forces the analyst to
set out the work method in detail before determining the time to be taken up by the work: accordingly,
incorrect methods can be avoided at the work station fight from the very start both from the production
and ergonomic point of view.
It must be stressed that MTM time standards refer to the time required for an average operator
working with average skills and average strength to perform a certain elementary motion under normal
THE G E N E R A L MODEL OF EXPOSURE ANALYSIS 25
conditions. No individual factors or coefficients are included (e.g. Physiological Need Supplement), no
fatigue factors (e.g. Tiring Effect), and no organizational factors or delays (e.g. Missing Material,
Breakdown, Waste, etc.).
The material used during the MTM analysis (i.e. videos, descriptions, sketches, breakdowns of the
work into elementary motions, time standards) is thus a valuable resource for an ergonomic analysis.
Productivity and ergonomics can be improved by achieving the goal of simplifying excessively
complex motions and reducing the number of useless ones.
a) MTM -1. MTM-1 is based on a very detailed analysis of motions in which the unit studied is the
ELEMENTARY MOTION, which is given this name because it cannot be broken down any further.
The Elementary Motions (Elementary Motions) in MTM-1 referred to the upper limbs are:
9 Reach;
9 Grasp;
9 Move;
9 Turn;
9 Position;
9 Apply Pressure;
9 Release;
9 Disengage.
Moreover, MTM-1 describes motions of the body, legs and feet as well as visual functions, which do
not involve the upper limbs.
The MTM-1 procedure requires the analyst to assign longer time values to" motions reaching longer
distances, regrasping the object a second time, readjusting grip or applying pressure/strength. Per se,
these considerations are signs that improvements are needed in the work method that the expert analyst
can detect during the planning phase.
b) UAS. The UAS (Universal Analysis System) is an MTM system which uses sets of predetermined
elementary motions to describe sequences of elementary operations. The time standards assigned to the
sets are the results of statistical studies of MTM-1 elementary motions.
MTM-UAS was developed to describe work sequences and to pre-define time standards in a typical
industrial context.
The sequence of UAS motions that involve the upper limbs are:
9 grasping and placing;

9 placing;
9 handling auxiliary tools;
9 operating;
9 motion cycles.
Besides these, the system also describes body movements and visual actions which do not involve
the upper limbs.
c) Interaction between MTM-1, UAS and the OCRA method. As indicated, the purpose of the MTM
analysis is to identify elementary motions in order to determine the time required to perform an
operation. This is fundamentally different to the OCRA analysis (illustrated in later chapters) which
aims instead to identify the number (and hence the frequency) of Technical Actions in a given time
frame.
The definition of a technical action is similar, but not identical, to that of the MTM-1 elementary
motions and UAS motion sequences. A technical action is defined as an action performed by the upper
limbs involving a complex biomechanical activity. This means that a technical action includes a certain
number of individual movements on the part of muscles, tendons, ligaments, and so on.
In general, OCRA focuses only on actions that involve the upper limbs and disregards visual actions
and actions which involve other body parts, for instance the lower limbs.
Since the aim is to estimate the biomechanical load exerted on the upper limbs, the main method for
studying technical actions is to identify how many technical actions the upper limbs perform in a given
unit of time (and in which posture, etc.), rather than the to calculate how long the technical action lasts.
The tables contained in this and the following chapters look in detail at the differences and
similarities between the MTM and OCRA approaches, in order to allow analysts to correctly evaluate
the number of Technical Actions in a job, based on an in-depth understanding of work analysis.
In particular, Table 4.2 supplies a series of definitions that will help carry out the analysis, especially
from the organizational standpoint.
The definitions are based on the classic method for designing work that is generally called "Times
and Methods"- a system used almost universally for repetitive manual tasks, although under different
names (MTM, UAS, etc.).
T H E G E N E R A L MODEL OF EXPOSURE ANALYSIS 27
Table 4.2 - Terminology used by the Times and Methods analyst
Time measurement unit: The TMU (Time Measurement Unit) is the unit of measurement of the MTM System:
1 TMU = 0.036 s = 0.060 cts
s (seconds) is one sixtieth of a minute:
1 s = 27.8 TMU = 1.67 cts
cts (hundredths) is one hundredth of a minute:
1 cts = 16.7 TMU = 0.60 s
Elementary motion (MTM): The smallest part of a manual operation which cannot be broken down any further;
every elementary motion corresponds to a predetermined time that is established on the basis of the nature of the
motion and the conditions under which it is performed. Its use is limited to the MTM System.
Operation or work phase" A set of elementary motions required to process a product: work phases or operations
describe and measure a working activity.
Processing cycle: A set of operations or work phases required to complete a sub-assembly to be transferred to a
subsequent processing phase; used for workstations not related to the assembly line. Includes the various
factors/coefficients/additions which are contractually performed by the workstation.
Assembly cycle: A set of operations or work phases required to process a product and enable it to be processed
at the next workstation; used for workstations related to the assembly line. Includes the factors/coefficients/
additions which are contractually performed by the workstation.
Individual workstation: Generally consists of a work bench or fixture on which a sub-assembly is prepared to
be processed in the next workstation; not related to the previous/subsequent workstations because of cushions up
and downstream (buffers with semi-finished work pieces). Generally manned by only one operator; by definition
without unsaturation.
Assembly line workstation: A workstation on an assembly line that processes products at a pace set by the
previous and/or subsequent operations; buffers minimal or non-existent between workstations. By definition
unsaturation is present.
Rate: Maximum time allowed to perform a processing or assembly cycle; obtained by dividing the time interval
(e.g. an hour, as measured in TMUs, in cts or seconds) by the number of pieces required in that same interval (the
unit of measurement is decided by the analyst).
Line rate: The time that elapses at a workstation between one piece and the next one.
Assembly line: Manufacturing line comprised of series (or parallel) workstations, where in each workstation
repeats the same operation on each work piece.
Continuous conveyor line: Type of mechanical assembly line in which the work piece is conveyed at a constant
speed along the line; there is no consensus on the part of the operator following the piece either on foot or aboard
a platform. The risk of failure to complete the piece may be diminished by allowing a supplementary distance
between one workstation and the next one. (This manufacturing concept is also sometimes called a chain system).
Paced line (constrained conveyor): Line that advances mechanically where the work piece is conveyed rapidly
from one workstation to the next, but remains stationary while it is being processed. The piece advances at a fixed
rate that is not determined by the operator and there is a risk that the piece might not be processed completely.
There are no buffers between the workstations, which results in a low WIP rate.
Mechanical non-constrained conveyor line (STOP&GO): Line that advances mechanically where the work
piece moves rapidly from one workstation and the next, but remains stationary while it is being processed.
Consensus to move the work piece is given by the operator by pressing a button or pedal. There are small cushions
between the workstations, such as buffers or simply accumulation distances, so that the workstations are non-
constrained and independent of each other.
Table 4.2- Continued
Manual non-constrained conveyor line: the work piece is stationary and moves to the next workstation as
commanded by the operator; there needs to be a buffer between each workstation to make the workstations non-
constrained. The pieces are conveyed manually by pushing or allowing to slide down rollers.
Islands: A group of workstations in which a series of more or less identical tasks or operations are performed on
the work piece; after completion at one island, the work piece is conveyed to the next island; there are substantial
buffers between the islands, which keep the work teams non-constrained.
Asynchronous conveyor line: A way of linking individual workstations or islands via a system of automatic
trolleys (AGV) which convey the work pieces from one workstation to another. In "taxi" systems, the AGVs
unload/collect work pieces upon arrival at the workstation; in "flow through" systems, the pieces are collected by
the AGVs while the process is taking place. Both systems are "capital intensive".
Line pitch: Dimension of the piece plus the space between pieces. Applied to continuous conveyor lines to
calculate the line rate; conversely, the workstation cycle time depends on the line speed and line pitch.
Line speed: Time taken by the product to cover a distance in the unit of time chosen by the analyst (generally
meters/second). Applied to continuous conveyor lines to calculate the line rate.
Performance of operator: A non dimensional number expressing the ability of a worker to perform a repetitive
task; takes into account the speed of execution, efficacy of execution and effort of the worker. This is a subjective
judgement on the part of the analyst and is applied only to work times measured using a stopwatch in order to
standardize these procedures. Not a typical parameter used by the MTM method.
Normal work speed: The speed at which a worker performs a certain job who has been trained to perform it under
normal conditions, and which can be maintained for the entire work shift; used for stopwatch measurements and
already considered as the basis for MTM-assigned times.
Saturation and unsaturation: Used for assembly line workstations. The saturation of a workstation and
consequently of the person manning it is defined as the estimated amount of work (cycle time) with respect to the
line rate, expressed in percentage terms; unsaturation is the complement at 100%.
Mean line saturation: The ratio of workstation cycle time (TC) saturation to the line TE or T.STD value,
expressed in percentage terms.
Bottleneck: Terms generally used to identify a low-capacity resource that places limitations on a system of linked
resources (such as a manufacturing system). In this context: the workstation on an assembly line that has the
highest cycle time (TC) has 100% saturation; this workstation determines the hourly output and the various
saturation/unsaturation statuses of the other workstations and the entire line.
Throughput time: Time spent by a component or part in the manufacturing system, between the start of
processing operations and delivery of the final product to the warehouse. Comprised of the value added time plus
the non value added time.
Value added time (VA): Time required to perform activities that add value to the product for the end user and for
which end users are therefore prepared to pay.
Non value added time (NYA): All times during which no value is added to the finished product. In other words,
queuing or buffer times, handling operations, inspections, product/component cleaning or touch-up operations.
Work in Progress (WIP): Company equity invested in components and supplies within the factory, the total of
which is proportional to the non added value activities or operations.
Elements characterizing the job or operation
MF machine stoppage: Set of actions performed by human operators without the support of automatically
running machines or equipment.
T H E G E N E R A L M O D E L OF E X P O S U R E A N A L Y S I S 29
Table 4.2 - Continued
TM, PT machine time or process time: Set of actions performed automatically by the machine or equipment
which is independent of the work of human operators.
ML machine work: Set of jobs or operations performed by operators while the machine or equipment is running
automatically.
TA active time: The time in the work cycle during which the operator works; corresponds 6 to the TA of the MFs
and the TA of the MLs.
TP passive time: The time in the work cycle during which the operator does not work; corresponds to the
difference between the TC and the TA.
TC cycle time: The S of the manual operations and machine times which determines the minimum time needed
to process the product.
TCT total cycle time: TC plus the % of factors/coefficients/additions contractually performed by the workstation.
TE effective time or STD.T standard time: The time assigned to a line or single workstation to perform a
particular task or job; utilized to calculate efficiency.
Hourly output (units/hour): The number of units produced in 1 hour of work; obtained by dividing the total
quantity of TMUs, seconds or cts contained in 1 hour by those relative to 1 TCT.
Productivity: Ratio of budgeted product cost and product cost after modifications to reduce the value of
manpower and materials required.
Efficiency: An index of how well direct manpower is used with respect to the budget.
5. WORK ORGANIZATION ANALYSIS:
TASK ANALYSIS, CYCLE TIME AND REST PERIODS
The first phase of analysis of organized work aims towards the study of upper limb bio-mechanical
overload risk. It implies the examination of the working shift, the selection of the task or tasks, the
presence or absence of pre-programmed pauses, of waiting times or dead times.
It is first of all necessary to pinpoint the presence of repetitive tasks, which are characterized by the
presence of cycles with technical actions of the upper limbs.
One or more repetitive tasks may be carried out during a working shift: they must be singly assessed
and described, with their duration in number of minutes within the whole of the shift.
In the same fashion, all the non-repetitive tasks must also be listed (or those tasks which are not
organized in cycles), and these too must be described in terms of their duration in minutes within the
working shift. Examples of such tasks could be, i.e., materials supply, preparation, cleaning, or transport.
There are tasks that do not imply any action of the upper limbs, such as, for instance, visual control
operations. Such tasks can be considered as a recovery period for the upper limbs, and their duration
must be quantified attentively (in minutes), together with their distribution within the shift.
Waiting times (relating to a machine), or idle times in general must not be counted, unless each
passive period reappears regularly and cyclically, and last at least 10 consecutive seconds every few
minutes of repetitive work. If so, the waiting period satisfies the requirements for a recovery period
within the shift. Lastly, it is necessary to make the sum total of all recovery periods calculated in the
above manner (see Chapter 10).
The physiological pause and/or rest period must be signalled as a recovery period when it is
expressed as pauses and/or interruptions which last at least five consecutive minutes.
Distribution of physiological pauses and/or rest periods within the shift requires, importantly, the study
of their total duration, of their distribution within the shift itself, and the duration of every interruption of
normal activity. If the pauses and/or interruptions of activity are distributed subjective, it is important to
report accurately on the average worker's behaviour whereby they are used within the shift. This data can
generally be obtained either by observation or by interviewing a significant operator sample.
The type of organizational analysis which is suggested here can be carried out by using the attached
Checklist 5.1, 5.2 and 5.3.
Checklist 5.1 describes the following: shift duration, presence of physiological and/or rest factors, and
in what percentage, distribution of pauses/interruptions of programmed tasks within the shift, presence and
duration of lunch break, average/subjective distribution of any other pauses and/or dead times.
Checklist 5.2 outlines and times all the various tasks which have been listed. Its aim is that of
calculating the net repetitive work times within one shift, and of outlining both distribution and duration
of the recovery periods which are represented by the official breaks and by any other interruption of
activity; also, any other task which may be considered as a recovery period (i.e., visual control
operations) must be calculated.
The lunch break must not be counted as being part of the working times, unless it is included by
worker's agreement within the shift duration times. It must be described by presence (is there a lunch
break?), and by duration.
For each repetitive task, once the real duration has been calculated (net of all other non-repetitive or
control tasks, and net of all pauses or interruptions lasting a minimum of 5 minutes) the actual number
of pieces to be completed by a single operator within a single shift must be defined.
The ratio between net repetitive working time and number of pieces to be processed in the shift gives
the net cycle time; this is of basic importance for the next calculation to be done: the frequency of action.
It must be pointed out that the number of pieces per shift is referred to the work carried out by a single
operator, and not by the whole processing line. In fact, if during work on line the operator is substituted
by a temporary replacement during the pauses, the number of pieces per shift to be considered is that
actually processed by the original operator him/herself: the pieces processed by the temporary
replacement must therefore be subtracted.
If the company employs incentive systems, then the net cycle time must be calculated according to
estimated yield (the higher the number of pieces per shift, the lower the cycle time).
It may be of importance to calculate the cycle time in terms of estimated yield (positive or negative),
both by working group and by single operator.
Checklist 5.3 supplies a useful suggestion for the recording of this data, both for the calculation of
the net cycle time per repetitive task and for the quantification of the cycle time in terms of estimated
yield per repetitive task.
The authors feel it may be useful to offer a practical example of the way in which the three analysis
forms can be filled in.
Example 5.A
Checklist 5.1A-5.2A-5.3A describe the work carried out by a group of operators who rotate on two
different tasks.
The work is organized in two 480-minute shifts; there is a 30-minute lunch break in each shift. The rest
factor used is equal to 8% (38.4 minutes), distributed upon three pauses, two of which last 15 minutes
each (during the first half of the shifts), and one which lasts 8.4 minutes (during the second half of the
shifts) (please see Checklist 5.1A).
The net repetitive task time is equal to 321.6 minutes, net of all pauses and of other non-repetitive duties
(materials supply, preparation, cleaning) (please see Checklist 5.2.A).
Once the net repetitive work time and the number of pieces (per shift per task) done have been
estimated, the net cycle time is calculated (Checklist 5.3A).
Lastly, because some workers have higher yields than others (120), the number of pieces per shift is
assessed incrementally, and the cycle time is assessed in terms of estimated yield.
There are working situations where even 10 or more tasks are carried out on a rotation basis per
worker. The succession is not daily, but rather weekly, or even monthly b a s i s - sometimes it is even
seasonal. In such cases, the most representative tasks by duration and intensity must be found (up to 5
or 6 tasks it is still possible to carry out an overall analysis), and a percentage weekly/monthly/seasonal
distribution must be calculated.
This distribution will then be related to a hypothetical working day, to calculate the exposure index;
starting from the estimated percentages, the "possible" (or "feasible") minutes per shift will have to be
re-calculated.
W O R K O R G A N I Z A T I O N ANALYSIS: TASK ANALYSIS, CYCLE TIME A N D REST PERIODS 33
Checklist 5.1.A (Example 5.A)
INFORMATION ON JOB ORGANIZATION

FOR OPERATORS/S:
N A M E / S ...... AC, GP, DA, GH, BP, BB, CF...........................................................................................
PERIOD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
O P E R A T I O N WELD BRACKET AND PUNCH HOLE
9 Duration of shift/s I~ 1st shift from...6AM...; to 2.30PM...; minutes...480
minutes...480
2 nd shift from...2.30PM; to 11PM ...... 9 minutes ......
Physiological factors and rest factors I~ physiological factor I~ minutes (1 st shift)...38.4 .........
. . . . . . . . .
I--I minutes (2 nd shift) ...38.4 .........

I~ rest factor (including r--I minutes (3 rd shift) ..................
physiological recovery)
...... 8 . . . %
minutes (single shift) ..................
Are physiological recoveries and/or rest factors distributed subjectively?

I-I YES I~ NO
If physiological recoveries and/or rest factors are subjectively distributed, indicate their average use.
If the aforementioned factors are distribued on a planned basis, indicate the duration of breaks:
Duration from.., a... Duration from.., a... Duration from.., a... Duration from.., a...
Meal break 30 min. 11-11.30 AM 30 min. 7.30-8 PM

. . . . . . . o~ . . . . . . . . o . . . . . . . . ~ . . . . . . . . . . . . . . .
1st break 15 min. 7.30-7.45 AM 15 min. 3.45-4 PM

2 nd break 15 min. 9.30-9.45 AM 15 min. 5.45-6 PM
3 rd break 8.4 min. 12,40-12.48 AM 8.4 min. 9.20-9.28 PM
. . . . . . . . . , ~ u . . . . . . . . . . . . . .
. . . . . . . . . . . . , . . . . . . . . . . . O00OO . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . o,,ooo o . o . . o .
I st shift 2 nd shift 3 rd shift S i n g l e shift

LIST OF OPERATIONS PERFORMED DURING THE SHIFT

List of operations performed during the shift ( 17 1st r--] 2 nd ~ 3 rd I-ISingle shift)
Duration (min)
17 In cycles A WELD BRACKET (70%) ........ 225.2 ................
B PUNCH END HOLE (30%) ......... 9 6 . 4 . . . . . . . . . . . . . . . . .

321, 6 Repetitive work
C .............................................................. net time
O .............................................................. rain.
E ..............................................................
I---I Not in cycles X supply 10%
Y prepare 10% . . . . . . . . . . 8 IIOOOIIO. . . . . . . . .
120 Non repetitive

Z clean 5% ..........24 .................
time net time
W transport min.
J ...............................................................
H ..............................................................
K ..............................................................
r--] WORK THAT 9 Visual inspection

CAN BE 000
CONSIDERED
AS RECOVERY 9 Waiting times: Passive times with Recovery time
periods of inactivity lasting in excess of r7YES ~NO
min. (do not include
10 consecutive seconds passive times in
recovery time)
Total passive time per cycle ......... sec
from . . 6 A M . . to . . 2 . 3 0 P M
38.4 Physiologica
6AMI 7/~M I 8~M 9AIM / I~AM 11AI~30AMI~I 12"7PI I"30PM
I 12"30PMI st SHIFT
factor and/or rest
min. factor
I st hour 15 MIN 15 MIN CANTEEN 84 MIN - - BREAKS (interruption of
from 2.30PM to 11PM activity for at
2.30PMI13"30PM1 4"3IOPMI5"301P
l MB
II 6.30PMI7.30IPM
~I______I8PM
9PMi 10PMI______
IllPM 2nd SH' Fm least 5
consecutive
1,t hour 15 MIN 15 MIN CANTEEN 84 MIN - - BREAKS minutes)
from ......... to ......... 4 8 0

Shift minutes
I I I I I I I I I I 3 rd SHIFT (total previous
1= hour min minutes must
from ......... to ......... match shift
duration
I I I I I I I___1 I I SINGLE DAILY minutes)
1= hour SHIFT
Describe the distribution of the various repetitive and non repetitive tasks, breaks and/or interruptions, meal breaks

DESCRIPTION OF P R O D U C T I O N AND NET CYCLE TIMES (EXCLUDING
P H Y S I O L O G I C A L FACTORS, REST FACTORS AND NON REPETITIVE OPERATIONS)
NAME . . . . . . . . , . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . , . . . , .
OPERATION
. . . . . . . . . , . . . . . . . . . . . . , , . , , . . . . . . . . . . . . . . . .
PERIOD , . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . .
Repetitive operations (in cycles) with the shift (r-] 1st D 2 nd ['-]3 rd ['-I Single shift )
Duration (min.) No. of units per shift Net cycle times (*)
(A) (B) (**) (A/B)
A 225.2 1500
96.4 964
C
(*) Net cycle times must include any passive cycle times within repetitive tasks.
(**) A/B x 60 if the cycle time is in seconds; A/B if it is in minutes.
Incentives: ~YES I-] NO

If yes, from 100 to . . . . . . . . . . . . . . . . .
Average efficiency: ~ ' of the individual worker ............ 120 (AG and GF) ...................
~ of t h e group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Net cycle times considering efficiency level"
of the individual worker ....................................................
[-1 of the group ....................................................................
Duration Estimated efficiency Increase or decrease in Cycle time in estimated

(minutes) no. of units/shift efficiency (sec.)
(A) individual group individual group individual group
..
A 120
225.2 1800 7.5
96.4 120 1157

C
Signature and date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Example 5.B
Checklist 5.2B shows a reconstruction of tasks with a seasonal shift system, in a fictitious and
representative daily distribution referring to a food packaging company that cans its products in glass
jars.
This shows how, generally speaking, the number of cycles and the net duration of each cycle within
each repetitive task must be counted. The number of cycles often coincides with the number of pieces
to be processed within the shift.
Example 5.C
9 440 PISTONS MUST BE ASSEMBLED IN 220 MINUTES WITHIN AN 8-HOUR SHIFT
9 ASSEMBLY OF EACH PISTON CAN BE CONSIDERED AS BEING ONE CYCLE
9 ONE CYCLE LASTS 30 SECONDS (440 PISTONS IN 220 MINUTES NET).
The value of the cycle time is obtained with the following Formula:
220 minutes x 60 (seconds per minute)
440 pieces
Sometimes, describing the cycle may be difficult, especially if it is not clearly identifiable with the
processing of a single part or object; it is always up to the experience and discretion of the operator. It
should however be pointed out that the relevant choice is only valid for the successive re-aggregation of
data and does not influence in any way the estimation of the frequency of action.
This concept will be developed more extensively within the chapter dealing specifically with the
calculation of the frequencies of action (Chapter 6).
Example 5.D
Take a task consisting of the preparation of a box containing various objects, packaging it, closing it and
shelving it. It is advisable to consider the total packaging and shelving time as one cycle, rather that
considering all the single actions necessary for the placement of the single objects within the box itself.
PACKAGING Pick up object 40 technical actions in 40 seconds

OF ONE BOX (1 second) Repeats 20 times
= Put object in box
1 CYCLE (1 second)
(time" 43 sec.) Close the box 3 technical actions in 3 seconds

Pick up the box
Put the box on the shelf
However, if each single object must first be packaged thoroughly, and then put into the box, the
working phase becomes more complex, with a series of complex technical actions, and consequently
Checklist 5.2.B (Example 5.B)

List of operations performed during the shift (l~'lst l~2nd I-'13 rd I-'1 Single shift)
Duration (min)
I ~ l n cycles A SORT OLIVES (20%) 86

B SORT AUBERGINES (20%) 86
430 Repetitive work
C SORT ARTICHOKES (20%) 86
net time
D FILL JARS (30%) 129 rnin.
E PREPARE TUNA (5%) 21,5
F PREPARE MIXED VEGETABLES (5%) 21,5
l~Not in cycles X supply ........... 15 .................
Y prepare
30
Non repetitive
Z clean ........... 15 .................
time net time
min.
W transport
J ...............................................................
H ..............................................................
K ..............................................................
I"-! WORK THAT 9 Visual inspection

CAN BE
CONSIDERED
Waiting times: Passive times with Recovery time
AS RECOVERY
periods of inactivity lasting in excess of DYES I~NO min. (do not include
recovery time)
Total passive time per cycle ......... sec.
from ...... to ...... 20 Physiologica

factor and/or rest
I I ! I I ! I I I I 1st SHIFT factor
1st hour min.
(interruption of
from ...... to ...... activity for at
2.30PM 3.30PM 4.30PM 5.30PM 6.30PM 7.30PM 8PM 9PM 10PM 11AMPM least 5
consecutive
I I I I I I I I I I 2nd SHIFT minutes)
1st hour
from ...... to ......
480
I I I I I I I I I I 3 rd SHIFT Shift minutes
(total previous
1,t hour min. minutes must
from ...... to ...... match shift
duration
] I ] / I ~ I I / I I SINGLE DALLY minutes)
1,t hour 10 M I N . CANTEEN 10 MIN --BREAKS SHIFT
Describe the distribution of the various repetitive and non repetitive tasks, breaks and/or interruptions, meal breaks.
longer times. In such cases, it is more significant to consider the processing of a single object or part as
a cycle, and the rest as additional actions occurring with lower frequency.
If the cycle time should turn out to be particularly long, it is possible to consider the closing and
shelving (transport) of the box as a non-repetitive task, which means counting it as a time to be
subtracted from the net time of repetitive task.
Example 5.E
Take a task which consists of packaging a box full of Easter eggs. The wrapping of each single egg
requires 60 seconds. A full box is taken and put on a shelf every 20 minutes.
Repetitive task 1 CYCLE - Take one egg 13 technical actions

(time 60 seconds): - Take one sheet paper every 60 seconds
wrapping up - Put sheet on table
one Easter egg. - Put egg on sheet
- Fold sheet over egg

-Wrap sheet around egg
- Take ribbon
- Cut ribbon
- Wrap ribbon around
paper
- Tie ribbon
- Fix knot
- Take wrapped egg

- Put egg in box
Non repetitive task 5 seconds - Close box 5 technical actions

every 20 minutes: - Pick up box every 20 minutes
- Put box on shelf lasting 5 seconds each
- Take another box
- Put that box on
- Work surface
WORK O R G A N I Z A T I O N ANALYSIS" TASK ANALYSIS, CYCLE TIME AND REST PERIODS 39
Checklist 5.1

FOR OPERATOR/S:
NAME/S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PERIOD ................................................. OPERATION ...........................................................................
9 Duration of shift/s I--I 1st shift from . . . . . . . . . ; to . . . . . . . . . ; minutes . . . . . . . . .
I-] 2 nd shift from . . . . . . . . . ; to . . . . . . . . . ; minutes . . . . . . . . .
I-1 3 rd shift from . . . . . . . . . ; to . . . . . . . . . ; minutes . . . . . . . . .
I-] single shift from . . . . . . . . . ; to . . . . . . . . . ; minutes . . . . . . . . .
Physiological factors and rest factors I--I physiological factor r--i minutes (1st shift) . . . . . . . . . . . . . . . . . .
. . . . . . . . .
I---! minutes (2 nd shift) . . . . . . . . . . . . . . . . . .

I--I rest factor (including
physiological recovery)
l--] minutes (3 rd shift) . . . . . . . . . . . . . . . . . .
. . . . . . . . .
9 minutes (single shift) . . . . . . . . . . . .
9 Are physiological recoveries a n d / o r rest factors distributed subjectively?
I---I Y E S I-1 NO
If physiological recoveries a n d / o r rest factors are subjectively distributed, indicate their a v e r a g e use.
If the a f o r e m e n t i o n e d factors are distribued on a planned basis, indicate the duration of breaks:
Meal break . . . . . . . . . ~ 1 7 6 1. 7 . 6 1. 7 . 6 ~ 1 7 6 1 7. 6 . . . . . . . . . . . . . . . . . . . . . . . . ~ . . . . . . . . . . . . . . .
1 st break . . . . . . . . . . . . . . . . . . . . ~ . . . . . . . . . . . . . . . . . . . . . . ~176 .~176 . . . . . . . . . . . .
2 nd break . . . . . . . . ~ . . . . . . . . . . . . . . . . . . . . . . .
3 rd break . . . . 9 ~ . . . . 9 . . . . . . . . . . . . . . . . 9 1 7 6 1 4 9
. . . . . . . . . . . . . . 9 . . . . ~ . . . . . . . 9 1 7 6 . . . . . . .~ . . . . . . . . . . . . . . . . . . . . . . . . ~ 1 7 6 1 7 6 1 7 6 1 7 6 1 4 9 . 1 ~ 4 1 9 7 1 6 7 16 71 67 16 71 67 16 71 67 16 7 6 1 7 6 1 7 6 1 7 6 1 7 6 1 7 6 1 7 6 1 7
. . . . . . . . . . . . . . . . . .
I st shift 2 nd shift 3 rd shift S i n g l e shift

Checklist 5.2

List of operations performed during the shift (l-]1 st r-12 nd r-13 rd ~ single shift)
Duration (min)
I ' l In cycles A ..............................................................
a ...............................................................
Repetitive work
C . . . . . . . . . . . . . 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
net time
min.
D . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05 . . . . . .
E ..............................................................
r-I Not in cycles X supply
Y prepare
Z clean Non repetitive

time net time
min.
W transport
J ...............................................................
H ..............................................................
K . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . . . . . . . . . . . . . . . .
I--! WORK THAT 9 Visual inspection

CAN BE
CONSIDERED
AS RECOVERY Waiting times: Passive times with Recovery time
periods of inactivity lasting in excess of I-IYES I--! NO min. (do not include
recovery time)
from ...... to ...... Physiologica

I I I I I I ,,,
I I I I 1 st SHIFT factor and/or rest
1st hour min. factor
(interruption of
least 5
I I I I I I I I I I 2 nd SHIFT consecutive
1st hour minutes)
from ...... to ......
I I I I I I I I I I 3 rd SHIFT Shift minutes

(total previous
1st hour min. minutes must
duration
I I I I I I I I I I SINGLE DAILY minutes)
I st hour SHIFT
Describe the distribution of the various repetitive and non repetitive tasks, breaks and/or interruptions, meal breaks.
WORK ORGANIZATION ANALYSIS: TASK ANALYSIS, CYCLE TIME AND REST PERIODS 41
Checklist 5.3
DESCRIPTION OF PRODUCTION AND NET CYCLE TIMES (EXCLUDING

PHYSIOLOGICAL FACTORS, REST FACTORS AND NON REPETITIVE OPERATIONS)
NAME .................................................. OPERATION ........................................... PERIOD .................................
9 Repetitive operations (in cycles) with the shift ( F I 1st r-] 2 nd I-]3 rd r l single shift)
(A) (g) (**) (A/B)
A
9 Incentives: i-1 YES [-] NO

If yes, from 100 to . . . . . . . . . . . . . . . . .
Average efficiency: F! of the individual worker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
r-i of the group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Net cycle times considering efficiency level:
r--! of the individual worker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
r--i of the group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Duration Increase or decrease in Cycle time in estimated

Estimated efficiency
..... i J
(A) individual group individual group individual group

9 i

6. ANALYSIS OF REPETITIVENESS AND FREQUENCY OF ACTION
General indications
Repetitiveness is probably the most important risk condition, so much so that related syndromes have
often been defined as "repetitive strain injuries". Characterization of repetitiveness can be used as a
discriminating factor to distinguish working tasks which should be submitted to an evaluation (which
does not mean that they are necessarily at risk).
Characterization implies that any repetitive task for the upper limbs should be submitted to an analysis
if it requires carrying out consecutively, for at least 1-2 hour/day, working cycles similar to each other,
and of relatively short duration (a few minutes), which are carried out via actions of the upper limbs.
Once established which tasks are actually repetitive and should be submitted to an analysis, the most
important problem is the quantification/assessment of repetitiveness. In the literature, on the basis of a
work by Silverstein et al. (1986), a proposal can be found for the characterization of repetitiveness based
on cycle duration. In particular, high repetitiveness has been postulated in the presence of cycles lasting
less than 30 seconds, and/or whenever 50% of cycle time is used carrying out the same type of action. In
real-life situations it is possible that very short cycles will not require the repetition of gestures and
movements at very high frequency: conversely, longer cycles can require high action frequencies.
As some Authors suggest, it would be excellent for assessments to measure the frequency of single
joint movements. In fact, the greatest risk level occurs when the same type of movement is repeated
frequently by the same joint. If the type of measurements chosen is feasible directly in the field, and can
be carried out by company technicians, then a direct measurement of joint movement frequency is not
possible, because it requires measurement of the frequencies of every type of movement made (flexion,
extension, inclination, etc.), for each of the main joints and most often for both arms.
Some Authors suggest only describing the movement frequency of the wrist, and considering the
result as predictive for carpal tunnel syndromes (CTS). It must be remembered that a high prevalence
of other upper limb pathologies has been described for some working tasks (i.e., epicondylitis, scapulo-
humeral periarthritis), and these were obviously due to the presence of repetitive movements
overloading other joints, such as the elbow and shoulder. Therefore, it is necessary to carefully observe
all the main joints of both arms
One suggestion which can be implemented in the "field" for frequency measurement, is that of
counting, very carefully and analytically, all the technical actions, as defined in Table 6.1 and 6.2, and
to then refer them to the time unit of reference (no. of technical actions per minute).
Subseguently, an analysis of postures (the type of quantitative and qualitative joint involvement, the
static or dynamic component of movement) will make it possible to obtain a general estimation of the
degree of repetitiveness and of the duration of single joint movements within the sequence of technical
actions.
44 RISK ASSESSMENT A N D M A N A G E M E N T OF REPETITIVE M O V E M E N T S A N D EXERTIONS OF U P P E R LIMBS
For a description of the technical actions it is essential to make a video of the working tasks, which
should then be viewed in slow-motion.
If the task is technically complex, the description of the action must absolutely be prepared together
with personnel having specific experience in that task.
Often, the company itself already has available documentation (for ex., "times and methods" work
analyzes) which extensively describes the carrying out of the task: such documentation includes the
numbered list and timing of successive movements or operations. For an efficient study of repetitive
movement tasks and, more specifically, to identify and count the technical actions, the following order
of actions is suggested.
a) Preparation of a video
The work carried out during the shift by the operator, or by a homogeneous group of operators, is
submitted to a work analysis to establish the repetitive tasks characterized by cycles. It is sufficient
to film a few cycles for every repetitive task (three or four). If the nature of the cycle makes it
possible to carry out operations in various different ways, then it may be useful to film 2 or 3
operators while they are working on the same cycle. If there are technical obstacles to making a video
of the operator from the front, which would make it possible to film both arms at the same time, it
is suggested to film the right arm first, and then the left. The view field must include all the area from
the shoulder, including all the trunk, and the hand.
b) Detecting each single technical action
Technical actions have already been described as implying arthro-musculo-tendon activity of the
upper limbs: they should not be identified with the single joint movements, but rather with the total
movements - of one or more joint segments - which enable the completion of a simple working task.
As previously explained, the aim of the MTM analysis is that of pinpointing the elementary
movements necessary to determine the time required to accomplish a given operation. The more
incongruous the posture required for the task, the longer the time required (e.g., because of the
distance, etc.); or, the greater the force required, the longer the time (weight of the object, degree of
precision required, handling difficulties, etc.). Therefore, the presence of risk factors that may
overload the upper limbs presupposes a lengthening of the task execution times.
The OCRA analysis starts from the need to analyze each risk factor singly, and then to put the
exposure study together with the use of a single formula that enables a study of the results of all the
possible various combinations of the different risk factors put together. In this way, it is possible to
establish the critical elements on which to base successive actions, during the designing, or the re-
designing, phase.
To study the frequency risk, the technical actions carried out during the time unit must be listed; for
each single one, a successive analysis of posture and force will be made, and any additional risk factors
must also be analyzed.
As pointed out previously, the technical actions should not be identified as the joint movements
(biomechanical analysis), nor with elementary movements (MTM1 analysis). To make action frequency
analyzes more accessible, a conventional measurement unit has been chosen, the "technical action" of
the upper limb, because it is actually aimed towards the description of the technical movement carried
out by the operator, and is therefore more easily recognisable by an external observer.
This definition is very similar, although not identical, to the UAS movement sequences description.
Table 6.1 lists the criteria for the definition and counting of technical actions, and table 6.2
underlines, in general terms, the similarities and divergences with respect to the UAS-MTM method.
ANALYSIS OF REPETITIVENESS AND FREQUENCY OF ACTION 45
Table 6.1 - Criteria for the definition and counting of technical actions
Reach move REACH means shifting the hand towards a pre-fixed destination.
MOVE means transporting an object to a given destination by using the upper
limb.
Reaching an object should be considered as an action exclusively when the
object is positioned beyond the reach of the length of the extended arm of the
operator and is not reachable by walking. The operator must then move both
the trunk and the shoulder to reach the object. If that work-place is used by
both men and women, or by women alone, the measurement of the length of
the extended arm corresponds to 50 cm (5 th percentile for females), and this
length must be used as a reference point.
Moving an object should be considered as an action exclusively when the
object weighs more then 2 kg in grip (or 1 kg in pinch) and the upper limb has
a wide shoulder movement covering an area > 1 m.
Grasp/Take Gripping an object with the hand or fingers, to carry out an activity or task, is
a technical action.
SYNONYMS: take, hold, grip again, take again.
Grasp with one hand The actions of gripping with the right hand and gripping again with the left
grasp again with other hand must be counted as single actions and ascribed to the limb that actually carried
them out.
Position Positioning an object or a tool in a pre-established point constitutes a technical
action.
SYNONYMS: position, lean, put, arrange, put down; equally, to re-position,
put back, etc.
Putting in, putting out The action of putting in or pulling out must be considered as a technical action,
when the use of force is required.
SYNONYMS: to extract, to insert.
Push/Pull These must be counted as actions because they stem from the need of applying
force, although maybe only a little, aimed towards obtaining a specific result.
SYNONYMS: to take apart, to press.
Release, let go If, once an object is no longer necessary, it is simply "released" by opening the
hand, or the fingers, then the action must not be considered as a technical
action (it is a passive return, or by dropping).
Start-up This must be considered as an action when start-up of a tool requires the use
of a push-button or lever by parts of the hand, or by one or more fingers. If
start-up is done repeatedly without shifting the tool, then consider one action
for every start-up.
SYNONYMS: press button, lower lever.
Specific actions during In addition to those listed here, many technical actions exist, specifically
a processing phase describing the processing of a part/object, i.e.:
bend or fold
bend or curve, deflect
squeeze, rotate, turn
settle, to shape
lower, hit, beat
brush (count each brush passage on part to be painted)

grate (count each passage on part to be grated)
smooth or polish (count each passage on part to polish)
clean (count each passage on part to clean)
hammer (count each single hit on part)
throw, etc.
Each one of these actions must be described and counted once for every
repetition, e.g., Turn twice = 2 technical actions
Lower 3 times = 3 technical actions
Pass the brush 4 times = 4 technical actions.
To walk, to do visual control These must not be considered as technical actions because they do not
imply any activity of the upper limbs.
To transport If an object weighing 3 or more kgis transported for at least 1 metre, the
upper limb that supports the weight is the one that carries out the technical
action "to transport". One metre means a true transport action (two steps).
PLEASE NOTE = identical actions must still be counted every time that they are repeated. It must be remembered that this
risk analysis method counts the single technical actions, and not their duration time, because the aim is that of defining the
frequency of action (no. of actions per minute).
Table 6.2 - The OCRA criteria f o r the interpretation o f a technical action, according to the M T M and UAS method
movement sequence definition
MTM OCRA interpretation.

Reach Basic rule: 0 technical actions. Exception: 1 technical action if the object is
beyond the reach of extended arm (or 50 cm for mixed job posts), and if
torsion/flexion movements of the trunk are necessary because the object
cannot be reached by walking.
Grip Basic rule: 1 technical action. Exception: 0 technical actions for G5 (grip with
contact). PLEASE NOTE: G2 (adapt grip) must be counted every time it
appears in the cycle. G3 (grip with other hand) must be counted as 1 action for
the limb to which the object is transferred.
Move Basic rule: 0 technical actions if the aim is that of positioning an object.
Exception: 1 technical action if the object is beyond the reach of the extended
arm (or 50 cm for mixed working posts), and if torsion/flexion movements of
the trunk are necessary because it is not possible to reduce the distance by
walking. 1 technical action if the object is very bulky and/or if wide
movements are required, involving more than one joint importantly. PLEASE
NOTE: the weight of the object is considered within the FORCE factor in the
OCRA method. For cycles of movements (e.g., to hammer, screw with a
screwdriver, spanner or bare hands) please see footnote (*).
Turn Basic rule: 1 technical action for T-S, T-M and T-L. PLEASE NOTE: if T is
with empty hand, then = 0 technical actions.
ANALYSIS OF REPETITIVENESS A N D F R E Q U E N C Y OF ACTION 47
Position Basic rule: 1 technical action. Exceptions: P3 must be counted as 2 technical

actions. PLEASE NOTE: no technical actions must be assigned for APAs and
APBs which are already contained within P2 and P3.
Apply Pressure Basic rule: 1 technical action for APA and APB.
Release Basic rule: 0 technical actions for RL1 and RL2.
Disengage Basic rule: 1 technical action. Exception: D3 must be counted as 2 technical actions.
MTM-1 elementary movement Basic rule: one technical action is counted for every repetition (without
cycles counting the various Move, Reach, Grip, Release, etc. which actually make up
the cycle itself).
Consecutive movements These should be made up with the above rules.
Combined movements Basic rule: a technical action must not necessarily be associated to the
movement which determines time, but rather to the movement which implies
biomechanical commitment.
Simultaneous movements Basic rule: the upper limbs must be analyzed separately, according to the
above-described rules.
Visual functions Basic rule: 0 technical actions.
Movements of the body Basic rule: 0 technical actions. Exception: 1 technical action if the upper limbs
transport a Net Actual Weight >3 kg over a distance > 1 m.
Leg and feet movements Basic rule: 0 technical actions.
UAS OCRA interpretation.

Take and position (AA-AN) Basic rule: 2 technical actions. Exceptions: one technical action must be added
for the presence of each of the following situations: Reach or Move beyond the
length of the extended arm (or 50 cm if the post is used by both men and
women), or if the object is very bulky and/or wide or extensive movements are
necessary, involving more joints significantly. Adapting the grip (G2),
Gripping with the other hand (G3), rotate with the object in the hand (T-S, T-
M or T-L), Apply pressure (APA or APB) apart from those which are already
included in Positioning (P2, P3), Separating (D).
Put down (PA, PB, PC) Basic rule: 1 technical action. Exceptions: 1 technical action must be added for
the presence of each of the following conditions: Move beyond reach of
extended arm (or 50 cm if the post is used by both men and women), or if the
object is very bulky, and/or if wide and extensive movements involving more
joints significantly are required. Adjust grip (G2), Grip with other hand (G3),
Rotate with object in hand (T-M or T-L), Apply pressure (APA), apart from all
those which are already included in positioning (P2, P3), Separating (D).
Handle auxiliary tools Basic rule: 3 technical actions (which include gripping the tool, positioning it
(HA, HB, HC) and first use). Exceptions: 1 technical action must be added for the presence
of each of the following conditions: Reach or Move beyond the length of the
extended arm (or 50 cm if the post is used by both men and women), Adjust
grip (G2), Grip with other hand (G3), Rotate with object in hand (T-S, T-M or
T-L),Apply pressure (APA), apart from those already included in Positioning
(P2, P3), Separating (D) to extract the tool.
48 RISK ASSESSMENT A N D M A N A G E M E N T OF REPETITIVE MOVEMENTS A N D EXERTIONS OF UPPER LIMBS
Start-up (BA, BB) Basic rule: 1 technical action for BA (simple start-up), 2 technical actions for
BB (composite start-up).
Movement cycles (ZA, ZB, ZC) Basic rule: 1 technical action is counted for every repetition (without counting
the various Move, Reach, Grip, Release, etc., which make up the cycle).
Block/Unblock (ZD) Basic rule: 1 technical action.
Visual control Basic rule: 0 technical actions.
Body movements Basic rule: 0 technical actions. Exception: 1 technical action if the upper limbs
transport an Actual Net Weight >3 kg over a distance > 1 m.
When reviewing the film in slow motion, all the technical actions carried out by the fight and left arm
must be listed in order of execution.
To point out the similarities and differences between technical action and the MTM element, six
"key" examples have been prepared. They are combinations of technical actions, and they are compared
to the two most classical methods for the organizational assessment of elements distribution into
working cycles: the original MTM 1 and UAS, which works by element aggregation.
In these examples, some simple tasks - or rather, some groups of actions - have been analyzed and
a comparative interpretation of the three analytical methods was thereby obtained, which underlined
both the similarities and the differences.
Example 6.1 (scheme 6.1): Pick up and place

The operation described here concerns the picking up of an object (a cylinder) from a container, and
then placing it into a hole on the workbench.
Basically, this is what we call PICK AND PLACE an object being processed.
The MTM method, which is the most classical one, pinpoints 5 elements: reach the cylinder, grip the
cylinder, move towards the bench, place into hole, release.
The element-aggregation MTM, or UAS, aggregates PICK AND PLACE into one single element.
Technical actions counted to estimate action frequency therefore only consider 2 actions: grip the
cylinder (PICK), and put the cylinder into the hole (PLACE). It is of paramount importance that the
actions are assigned to the arm that has actually done them.
In this case, picking or placing implies two separate technical actions for the right arm.
Please remember that, since the aggregated MTM (UAS) considers PICK AND PLACE as a single
element, it ascribes a longer time to it, while the counting of the technical actions is exclusively
"numerical". This is why PICK AND PLACE is given a value of 2, which means 2 technical actions.
Scheme 6.1 - (Example 6.1)
Description of the operation

Take a cylinder from a container on the right hand side of the operator, close to the body, and position it by
inserting it into a hole in the workpiece arriving at the bench ("close to the body" means an arm's length away).
MTM1 elements UAS elements OCRA technical actions

L R
1 reach cylinder 1 take and place 1 take cylinder
1 grasp cylinder 1 place cylinder

in hole
1 move toward bench
1 position in hole
1 release
Total 5 Total 1 Total 2
N.B. -"take" and "place" count as two actions attributed to the limb that performs them. "Reach" does not count as an action
because the object is close to the body, i.e. an arm's length away.
If it is necessary to re-grasp the workpiece before positioning it, the "re-grasping" would count as an action
Example 6.2 (scheme 6.2): Pick and place with transfer from one hand to the other and with
visual control
The operation described here is a pick and place operation with change of hands and visual control. The
operator grips the cylinder with the left hand, grips it again with the right hand, rotates it to control it
visually, positions it in the place required, always with the right hand. The operator has therefore carried
out one technical action with the left hand, and three with the right hand. MTM1 lists 12 items inclusive
of visual control, while UAS only lists three inclusive of visual control.
When counting technical actions, "visual control" is not considered, because it does not require any
mechanical action of the upper limbs. In this case, the operator actually "rotates" the cylinder to control
it visually: therefore, this "control" action is actually a "mechanical" action, and must therefore be
counted as such (rotation).
Example 6.3 (scheme 6.3): Pick and place while taking steps, and using a tool
The cylinder is in a container, 3 to 4 steps away from the workbench; it only weighs a few hundred
grams.
The operator grips the cylinder with the left hand, takes two steps and then slips the cylinder into its
slot, always with the left hand.
2 technical actions of the left upper limb will be counted here: grip and put in hole.
The action of walking is not counted because it is not done by the upper limbs.
In the MTM1 and UAS methods, walking will be counted, because the aim of these methods is that of
estimating the time necessary to carry out the complete task.
5~ RISK ASSESSMENT AND M A N A G E M E N T OF REPETITIVE MOVEMENTS AND EXERTIONS OF UPPER LIMBS
The right hand must grip a screw, and screw the cylinder 3 times (this means that to start-up the
automatic screw driver, the operator has to push a button three times). The technical actions outlined
here are: grip the tool, position the tool on the cylinder, screw three times (i.e., push the button thrice),
put tool back. The technical actions carried out by the fight hand are 6.
Generally speaking, walking does not interrupt the technical actions PICK AND PLACE (if the object
transported is not heavy).
Again generally speaking, the use of a tool includes picking it up, positioning it where it is needed,
activating it (if foreseen), putting it down when finished using it.
If the tool is suspended over the workbench with spring suspensions, and can go back to standby
position simply by opening the hand and letting it go, then the action of opening the hand at the end
must not be counted as a technical action (so the "release" action is really not counted here).
Example 6.4 (scheme 6.4): Pick and place while transporting a load
In this case, the operator must transport a load weighing 3 kg or more, from a container which is over
1 m away from the workbench, to the workbench itself. The technical actions which have been listed
are: grip the part, transport the part, place the part.
Example 6.5 (scheme 6.5): Pick and place an object which is far away but must be reached
without walking
It may happen that the object to be reached is further from the shoulder more than the length of the
extended arm, and that the operator cannot reach it by walking. The technical action "reach" has to be
added to the actions of pick and place.
Example 6.6 (scheme 6.6): The cyclical use of a tool with repeated and identical actions
The operator using a drill must make 3 holes in 3 different points. After having gripped the drill with
his right hand (1 st action), he positions it over the point where the hole must be drilled, pushes the
button, pushes to make the hole, and extracts the drill. These 4 latter actions are repeated 3 times
(TOTAL 12 actions), and at the end the drill is put down. The total number of technical actions is
therefore 14, all carried out by the fight upper limb.
When the action of pushing occurs, it must be counted because it requires the exertion of force to obtain
the desired result. The action of extraction must also be counted if the conditions explained in Table 6.1
are present (SEE "putting in", "putting out").
Scheme 6.2 - (Example 6.2)

Take a cylinder placed on the left hand side of the operator with the left hand (close to the body), re-grasp it with
the fight hand, visually inspect the unit to be inserted and insert it with the fight hand after rotating it (close to the
body).
MTMI elements UAS elements OCRA technical actions

L R
1 reach cylinder (L) 1 take and place (L) 1 take cylinder

1 grasp cylinder (L) 1 visual control 1 grasp cylinder
1 move toward right hand 1 position (R) 1 rotate
cylinder
1 reach with right hand 1 position
cylinder
1 grasp with right hand
1 release with left hand
1 move toward eyes
1 perform visual control
1 turn to orient
1 move into position
1 position
1 release with right hand
N.B. - Grasping with the left and re-grasping with the right qualify as two actions to be attributed to the limb performing them.
The object is rotated to inspect it visually. If the object is rotated several times, each rotation counts as an action
Scheme 6.3- (Example 6.3)

Walk to a container (2 steps away) located on the left, pick up a cylinder with the left hand, take 2 steps back to
the workstation, position the cylinder with the left hand, take a tool in the right hand, place it on the cylinder,
screw it three times, replace the tool (all picking and placing movements are close to the body).

L R
2 take steps 1 walk a distance of 1.5 meter 1 grasp cylinder

1 reach cylinder (L) 1 take and place on bench 1 insert cylinder
1 grasp cylinder (L) 1 walk to bench 1 grasp tool
1 move toward body 1 handle tool 1 place tool on
cylinder
Scheme 6.3 - (Example 6.3) - Continued

L R
2 walk to bench 3 screw cylinder with tool 3 screw cylinder

with tool
1 move cylinder to bench 1 replace tool
1 position on bench
1 release with left hand
1 reach tool (R)
1 grasp tool (R)
1 move toward cylinder
1 position on cylinder
1 move 1st screwing m o v e m e n t
1 move to extract
1 move to reposition
1 move 2 nd screwing m o v e m e n t
1 move to extract
1 move to reposition
1 move 3 rd screwing m o v e m e n t
1 move to extract
1 move to replace tool
1 position tool
1 release tool 09
Total 27 Total 7 Total 2 Total 6
N.B. - If the object being transported weighs less than 3 kgs, walking does not qualify as a technical action (transport). If the
tool is no longer shifted from its insertion point, nor visibly re-grasped, the number of technical actions corresponds to how
many times it is screwed or operated. If the tool is re-grasped, count how many times it is re-grasped and screwed. If it is
repositioned, count how many times it is repositioned and screwed

Walk to a container (2 steps away), pick up a piece weighing 6 kgs with the right hand and bring it to the work
bench.

L R
2 take steps 1 walk xxx meters 1 grasp piece
1 reach piece (R) 1 get and bring toward body 1 transport object
1 grasp piece ( R ) 1 walk to bench 1 position piece on bench
1 move toward body 1 position piece on bench

2 walk to bench
1 move to put down
1 position on bench
1 release piece ( R )
N.B. - "Transport" only appears when the weight of the object is more than 3 kgs and is transported at least 1 meter (2 steps)

Get a cylinder placed in a container more than an arm's length away and position it in the hole on the work
bench (it is not possible to walk over to the cylinder).

L R
1 reach cylinder 1 take and place 1 reach cylinder

1 grasp cylinder 1 take cylinder
1 move toward bench 1 position
cylinder in hole
1 position in hole
N.B. - When an object is located more than an arm's length away (and taking steps does not reduce the distance) the action of
"reaching" is also considered to be a technical action
Scheme 6. 6 - (Example 6.6)

Take a drill with the right hand and drill three holes, then replace the drill.

L R
1 handle the drill 1 grasp drill
P.T. (1 st drillhole) 1 place on 1st hole
1 place on 2 "d hole 1 press "operate"

button
1 operate to make 2 no hole 1 push to make
1st hole
P.T. (2 no drillhole) 1 remove drill
1 place on 3 ro hole 1 place on 2 no hole
1 operate to make 3 ro hole 1 press "operate"

button
P.T. (3 rd drillhole) 1 push to make

2 no hole
1 remove drill
1 place on 3 rd hole
1 press "operate"
button
1 push to make
3 rd hole
1 remove drill
1 replace drill
Total 5 Total 14
N.B. - "Operate" describes the action of using the hand or finger/s to operate the drill; "push" indicates the need to apply force,
even if minimal; "remove" indicates the need to perform the operation using force; "place" describes the need to place the tool
in a predetermined spot. All drillholes (in the example) require 4 actions; 3 drillholes involve 12 actions. If the tool were
"suspended" and returned to its original position passively, the "release" action would not be counted
There are cases in which some of the technical actions are not carried out during every single cycle,
but every few cycles. As previously explained, these actions must be counted within every cycle, but as
accurate fractions.
Table 6.3 describes a short, but complex, operating cycle which was recorded along an engine
assembly line. The actions listed therein are all ascribed to the right and/or left upper limb in
whole numbers (actions carried out every cycle), or in fractions (actions carried out every few
cycles).
ANALYSIS OF REPETITIVENESSAND FREQUENCY OF ACTION 55
Table 6.3 - Identification of technical actions repeated every cycle or every few cycles
Right Le~
- Pick and place gasket in site of muffola

- Use pliers, held in right hand, and hook 1st spring
- Use pliers, held in right hand, and hook 2 nd spring
- Shift calipers and press button
9 Correct spring position (once on 4 pieces)
Pick up unscrewing tool and position it
- 2/4 3/4
- Unscrew, or screw, spring 1/4 1/4
Put down tool
- 1/4
9 Substitute broken spring (once over 20 pieces)
Pick up unscrewing tool and position it
- 2/20 3/20
Unscrew spring (in 4 times)
- 4/20 4/20
- Hold tool 1/20
Pick out broken spring with pliers (no 2 times)
- 2/20
Pass tool into right hand
- 1/20
- Pick up spring and fit it over tool 1/20 2/20
Positon spring and screw in (4 times)
- 5/20 5/20
Put tool down
- 1/20
Total technical actions in the cycle 9.5 5
Net repetitive task time = 411 minutes

N~ of pieces per shift = 2075
Net cycle time = 11.9 sec./piece
N~ actions per cycle = right = 9.5
left = 5.0
C a l c u l a t i o n o f a c t i o n f r e q u e n c y
The following are already k n o w n from the previous work analysis:
- net repetitive task time;

- n u m b e r of cycles in the repetitive task (or number of parts processed during the shift;
- net duration of each cycle.
F r o m the description phase of the technical actions it is possible to extrapolate:
- the number of actions per cycle;

- the frequency of actions per time unit: NO. O F A C T I O N S / M I N U T E ;
- the overall number of actions contained within the task/s, and consequently, within the shift.
56 RISK A S S E S S M E N T A N D M A N A G E M E N T OF R E P E T I T I V E M O V E M E N T S A N D E X E R T I O N S OF U P P E R LIMBS
Example 6.7
Ten actions are carried out by the right upper limb, over a 20 second cycle, representative of a task
which lasts 450 minutes within a shift (1350 cycles): calculate the action frequency/minute
- frequency: 10 actions x 60 sec. = 30 actions/min.

per minute 20 sec. (cycle time)
- total n ~ of actions in the task and/or shift
30 actions/min. • 450 min. of repetitive work = 13.500 actions/shift
The decision to base the analysis on the frequency of the technical actions enables an easier and more
objective assessment of this fundamental factor for the characterization of exposure to repetitive
movements.
Technical actions, in fact, are commonly used in job planning: their definition and recognition are
both easy for technical personnel involved in production.
Frequency calculation as suggested here also helps to avoid mistakes due to the fact that workers have
the possibility to increase or decrease their working pace, at least in those tasks where productivity is
pre-set (no. of parts processed per shift). In fact, the method bases frequency calculations on:
a) the exact time available to carry out of the task;

b) the number of cycles (or pieces) required per shift;
c) the number of technical actions necessary to carry out a cycle.
The result obtained is actually the net average frequency, which is necessary to carry out each
working task over a definite assigned period of time.
Example 6.8
The data used here is that found in Chapter 5, under Example 5A, where the working shift described is
characterized by the carrying out of two repetitive tasks (A = welding the rod, B = cutting the terminal
hole). For each of these tasks, both technical actions and action frequencies are analyzed. Table 6.4
describes technical actions carried out by both the fight and left upper limbs in task A: they are 8 for
the fight and 6 for the left, over a net cycle time of 9 seconds. Action frequency per minute (please see
Table 6.5) is equal to 53.3 for the right, and 40 for the left. The same analysis has been carried out for
task B, where the action frequencies obtained were 63.7 actions for the right and 40 for the left.
Table 6.6 shows the calculation of the total actions carried out during the shift, separately for the fight
and left upper limb. These figures were obtained by multiplying the duration of each task by the
respective action frequency per minute" initially this gives partial results for the actions carried out
during the shift for that specific task. The sum total of the partial values gives (for each limb) the total
actions carried out during the shift for repetitive tasks.
ANALYSIS OF REPETITIVENESS A N D F R E Q U E N C Y OF ACTION 57
Example 6.9
Table 6.7 is used here to describe the technical actions. It is a different structure, including- in a single
t a b l e - the analysis of all the risk factors, to be carried out, action by action. This module offers an
accurate guide for risk factor analysis, and makes it particularly simple to quantify posture as a factor
in relation to time. The use of this module is particularly suitable for cycles of relatively short duration
(less than 30 seconds). For longer cycles, and in order to reduce analysis time, it is advisable to use
modules with a less analytical approach, which will be examined further on in the Chapters devoted
specifically to an analysis of the other risk factors.
Methods of analysis of action frequency for working cycles of long duration
There are cases where "critical" tasks can be observed, with working cycles of long duration, equal to.
or longer than. 5 minutes; generally speaking, these jobs are organized in "islands". where many
operations, instead of being "parcelled". are re-grouped and assigned to a single operator, who may
sometimes find him/herself both beginning and finishing the whole processing of a given product.
One might think that. if job are not broken down. and so are not repetitive, this would automatically
lead to the reduction or indeed to the abolition of the risk of bio-mechanical overload for the upper
limbs.
However. it has already been pointed out that cycle duration alone is not always a good risk indicator:
in fact. in terms of risk estimation, action frequency over a given time unit is much to be preferred.
There are cycles lasting a few seconds, with low action frequency (e.g. with many visual control
actions), while other extremely long cycles have a very high action frequency: although they apparently
seem to be less repetitive, they are to be considered at risk of bio-mechanical overload for the upper
limbs.
Therefore. when work is organized in "islands" which include "long" cycles, the job organization has
to be anal2~zed, because even if the task is less repetitive, there could be high exposure indices, due to
the presence of other risk factors like high frequency, or force, or inadequate recovery periods, etc.
In practice, an analysis of this kind imposes certain simplifications, because it is impossible to
analyze and count (watching a movie) all the technical actions over periods lasting 5 minutes or more.
In these cases, it may be of use to begin by finding "sub-groups" or phases of tasks which, together.
make up the cycle.
Example 6.10
It takes 30 minutes to assemble a sofa. The job can be subdivided into 4 separate phases" filling the
cushions, upholstering the sofa, putting the base in, final finishing.
The analysis of the technical actions is done by using a movie which must be studied in slow motion.
It is advisable to count the actions over a period of two non-consecutive minutes as "sample time" for
each one of the phases. The resulting frequency per minute must be considered as "average
representative frequency" of the phase (Table 6.8).
Table 6.4 - (Example 6.8)
TASK A 9 WELDING A ROD
RIGHT LEFT
1. PICK UP BOX (SEMIFINISHED PIECE) FROM CONVEYOR BELT
2. TURN PIECE
3. GRIP BOX XITH RIGHT HAND
4. POSITION BOX
5. PUSH BUTTONS
6. TAKES 3 RODS WITH RIGHT HAND
7. GRIP ROD WITH LEFT HAND
8. INSERT ROD (FROM THE LEFT)
9. INSERT THE THREE RODS WITH THE RIGHT HAND
10.
11.
12'
13.
14.
15.
16.
17.
:18
i9.
20.
21.
22. . . . . . . . . . . . . . .
23.
TOTAL TECHNICAL ACTIONS IN THE CYCLE
TASK A
T H E O R E T I C A L CYCLE TIME (sec) =

CYCLE TIME ACTUALLY OBSERVED (sec) =
NO. ACTIONS PER CYCLE RIGHT =
LEFT =
ACTION FREQUENCY
WITHIN THE CYCLE
NO. ACTIONS/MIN. = NO. ACTIONS

PER CYCLE • 60
TASK A RIGHT 53.3

LEFT 40
TASK B 9 CUTTING A TERMINAL HOLE
RIGHT LEFT
1. PICK BOX UP FROM CONTAINER
2. GRIP BOX
3. GRIP BOX AGAIN
4. PUT BOX INTO MOULD
5. SETTLE BOX PROPERLY INTO POSITION (EVERY 4 PIECES) 1/4
6. PUSH BUTTON
7. GRIP BOX
8. POSITION BOX ONTO CONVEYOR BELT
9. USE OF BRUSH WITH LUBRICATING OIL EVERY 26 PIECES (28 PASSAGES OF THE BRUSH) 28/26
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
TOTAL T E C H N I C A L ACTIONS IN THE C Y C L E 6,37
TASK B
T H E O R E T I C A L C Y C L E TIME (sec) = 6
C Y C L E TIME ACTUALLY OBSERVED (sec) = m
NO. ACTIONS PER C Y C L E RIGHT = 6,37

LEFT = 4
ACTION F R E Q U E N C Y IN THE C Y C L E
NO. ACTIONS/MIN. =
NO. ACTIONS C Y C L E X 60
C Y C L E TIME
TASK B R I G H T 63.7
LEFT 40
S U M M A R I S E D DATA F O R C A L C U L A T I N G T H E T O T A L N U M B E R O F T E C H N I C A L A C T I O N S
C A R R I E D O U T W I T H I N A S H I F T F O R R E P E T I T I V E TASKS
Line ................... Work-place W E L D I N G A ROD (A) .......... Shift... I e II...

9 CUTTING A TERMINAL HOLE (B)
Characterization o f repetitive tasks within a shift
RIGHT ARM LEFT ARM

AsKS ITASKS [TASKSITAsKs
A . B I C .
i I
A .
TASKS TASKS I TASKS TASKS
A B [ C
i
. D
9 Duration of task within the shift
I I I I
(min)
9 Average duration of cycle (sec) 9 I 6 I I I 9 6
Action frequency (n.actions/min) 53.3 ] 63.7 40 40
9 Total actions in task

I
Total actions in shift

Ae (total actions) 12,864 Ae (total actions)
(sum of A, B, C, D)
NOTE ..............................................................................................................................
Table 6 . 7 - (Example 6.9)
1st shift or s i n g l e shift 2 nd shift
[111[111II I I 1 I I ! ! I ! I
TASK ...... WELDING A ROD ......... risk s c o r i n g risk scoring
i
! POSTURE AND
FREQUENCY FORCE(BORG) ELBOW MOVEMENTS
l
i SHOULDER MOVEMENTS
DESCRIPTION OF THE TECHNICAL
! i
ACTIONS OF THE UPPER LIMBS o
z ~: > ~ ~
( d i s t i n g u i s h i n g b e t w e e n left a n d r i g h t )
...
PICK bP BOX ....
TURN PIECE
GRIP BOX WITH RIGHT HAND I
....
POSITION BOX I I
PUSH BUTTONS I I
TAKE 3RODS WITH RIGHT HAND "" 3
GRIP ROD WITH LEFT HAND
SLIP ROD IN SITE (FROM LEFT)
SLIP 2 RODS IN (WITH RIGHT HAND) . . . .
2
I ,.
EXTREME JOINT EXTREME JOINT

SINGLE MOVEMENTS OR MOVEMENTS PER CYCLE
"BORG"
8 9 53.3 225.2 12.003 MAINTENANCE FOR PERIODS. EQUAL TO:
VALUES
~x60" - - - X - - MULTIPLIED 41/3, 8 2/3 12 3/3 41/3.8 2/312 3/3 SUPINAT.
FREQUENCY CYCLE FREQUENCY/NET NO.ACTIONS
BY TIME OF CYCLE
CYCLERIGHT TIME MINUTE OPERATION IN SHIFT 2 1/3.4 2/3 6 3/3 PRONATZ.
RIGHT TIME/SHIFTI DX SX FRACTION OPERATOR MAKES
L
OF SAME GESTURES FOR 50%OF ! 2 1/3.4 2/3 6 3/3 FLEXION
SCORE
DURATION
6 9 40 225.2 9.008 FORCE THE TIME. OR KEEPS A R M S OPERATORPERFORMS
CONSTANTLY UPLIFTED BY , I GESTURESOF SAME TYPE
X60" = x =
+20~ FOR AT LEAST 50% OF CONTINUOUSLYFOR AT
FREQUENCY CYCLE FREQUENCYNET NO.ACTIONS CYCLE TIME: 4 LEAST 50% OF CYCLE 4
CYCLELEFT TIME MINUTE OPERATION IN SHIFT R
LEFT TIME/SHIFT
SCORE SCORE ~ R SCORE R
FORCE SHOULDER ELBOW
L L
Table 6. 8 - (Example 6.10)
Frequency:
N. of technical actions X minutes
I H Average
observation observation frequency
R L R L DX SX
A- cushion filling 60 51 68 56 64 53.5

B- upholstering of sofa 52 43 58 48 55 45.5
C- putting base in 41 35 45 39 43 37
D- final finishing 35 30 38 36 36 33
For each phase, duration within the cycle must be analyzed, and actual duration within the shift must
be calculated. This operation makes it possible to do a weighted calculation of the technical actions for
each phase within a shift and also the total actions within a shift (Table 6.9).
Table 6.9- (Example 6.10)
Phases Duration Duration in Duration Total

of the task (%) cycle in shift Actions per shift
(minutes) (minutes)
Right Left
A 20 6 86 5.504 4.601
B 40 12 172 9.460 7.826
C 15 4.5 64.5 2.773.5 2.386.5
D 25 7.5 107.5 3.870 3.547.5
Total 100 30 430 21.607.5 18.361
7. A N A L Y S I S A N D Q U A N T I F I C A T I O N OF FORCE USING
THE BORG SCALE
Preliminary data
Force is a good direct representation of the biomechanical commitment which is necessary to carry out
a given technical action, or sequence of actions. Force can be considered as "external" (applied force),
or internal (tension developed in the myo-tendineal and peri-articular tissues). The need to exert force
during working actions may relate to the moving around or maintenance of tools and objects, or to
keeping a certain physical posture with part of the body. The act of developing force can therefore be
related to static actions or to dynamic actions. In the former situation, one generally starts whit a static
load, which some authors describe as a distinct risk element (Hagberg et al., 1995).
The requirement to develop and use force in a repetitive fashion is signalled in the literature as a risk
factor, both for tendons and muscles. It has been extensively documented that there is a multiplicatory
effect between the factors of force and action frequency (Silverstein et al., 1985). This is particularly
true for tendon pathologies and for entrapment syndromes, such as, e.g., the carpal tunnel syndrome.
It is difficult to quantify force in real working environments. Some Authors use a semi-quantitative
estimation of external force by calculating the weights of the various objects handled; others suggest
the use of either mechanical or electronic dynamometres.
As for the quantification of internal force, the most widely suggested approach is the use of surface
electromyography.
Application of the Borg scale and estimation of physical effort
All of these methods have faults, from the technical point of view and they also present various
difficulties for implementation in the field (i.e.: surface EMG). This is because force cannot always be
expressed exactly by referring to the weight of the object handled (e.g., force exerted in using a manual
screw driver); moreover, accurate and reliable measurement tools are not always available.
One way of overcoming this difficulty could be recourse to a specific scale (Eastman Kodak C., 1983,
Putz Anderson, 1988), called the Category Scale for the Rating of Perceived Exertion, which extends
over a 10-point score and was initially conceived by Borg in 1980 (Borg, 1982): it can describe the
degree of muscle exertion which is perceived subjectively in a given segment of the body. The results
of the application of Borg's Scale, where it has been used over a sufficient number of individuals, have
turned out to be at least superficially comparable to those obtained with surface electromyography
[(Value number of Borg's Scale X 10 = percentage value with respect to the Maximum Voluntary
Contraction [MVC] as obtained by EMG) (Grant, A.K. et al., 1994). The quantification of exertion as
perceived by the whole of the upper limb should be done for every single technical action which goes
to make up the cycle. For practical purposes, actions requiting minimal muscle exertion can be
identified (Borg's Scale = 0 - 0.5), and then the exertion description procedure can be carried out, again
by using Borg's scale, but only for those actions, or groups of actions, which require a degree of force
which is not minimal. The average weighted score is then calculated for all the actions which are part
of a single cycle.
Practical experience gives rise to some suggestions for the practical application of this method,
making it easier to obtain reliable information and to overcome some of the uncertainties which
sometimes accompany the use of "subjective" data.
Table 7.1 suggests a model of application of Borg's scale to collect information on perceived physical
exertion. It is best to proceed by following the different operating stages listed hereunder:
- study of force, follows that on the sequence of technical actions. Previous knowledge on how the
cycle is carried out is necessary;
- the results are more effective if the workers are interviewed by the company technician (who could
be helped by an occupational doctor) who took part in the first phase of work analysis and in the
description of the technical actions;
- the operator must be questioned to see whether within the cycle there are any technical actions
requiring perceivable muscle exertion of the upper limbs;
- this way of posing the question is very important, because operators will often confuse muscle
exertion with the overall tiredness which they feel at the end of the shift;
Table 7.2 - An example of calculation of the average effort weighted over time
Action with force (a) (b) (a xb)

Time subdivision of cycle Borg's Scale score
A 0.67 (67%) 0.5 0.335

B 0.25 (25%) 2 0.5
C 0.08 (8%) 8 0.64
Total 1 (100%) Average weighted effort
E 1.475
- once the actions requiting exertion have been determined, operators will be asked to ascribe to each
one of them one of the descriptions indicated in the form, to which a progressive score is matched,
from 1 to 10 (Table 7.1): very very weak, very weak, weak, moderate, strong, very strong, very very
strong. The technician will match each one of the actions indicated to the right duration in seconds,
and then a percentage value with respect to cycle duration;
- since the exposure assessment procedure has basically preventative aims, it is very important to ask
the operator to explain the reason for the possible presence of physical exertion in the actions which
are pointed out as requiring force. This piece of information is of immediate practical interest
because, sometimes, the force needed to carry out an action is due to a technical defect in the product
or the tool or a fault in the mechanical side. Often, such problems, once identified, can be solved quite
easily;
- once the actions requiring physical exertion have been found, scored according to Borg, and weighted
according to cycle duration time, it is finally possible to score all the other actions with a single score;
ANALYSIS A N D Q U A N T I F I C A T I O N OF FORCE USING T H E BORG SCALE 65
- it is important that it should be the operator him/herself to ascribe the value of the perceived physical
effort during execution of an action. If the exertion index were given by an outside observer, major
mistakes would be made. In fact, especially for those actions carried out by small joints, or in special
joint positions (such as pushing a button, holding a lever with the fingers, pinching an object, etc.),
an outside observer cannot perceive the use of force, although this may be required to a high degree
of exertion;
- once the operator has supplied all relevant information, any actions requiting "PEAKS" (value~
above 5 in Borg's Scale) must be recorded and the average score must be calculated and weighted
with respect to all the actions composing the cycle;
- if any peaks greatly exceeding Borg's score 5 have been found, it is necessary to calculate to what
(%) extent they cover cycle time;
- if their overall duration occupies at least 10% of cycle time, it is necessary to highlight this datum,
because it becomes a high risk factor: the corresponding de-multiplicative factor for the calculation
of the OCRA index will in fact go down to 0.01 (see Chapter 11).
The calculation of the average exertion weighted over time involves multiplying the Borg Scale score
ascribed to each action by its percentage duration within the cycle: the partial results must then be added
together. This is demonstrated by example, in Table 7.2.
If several operators are carrying out the same task (although possibly in separate shifts), they should
all be interviewed. The more operators are interviewed, the more reliable the average weighted index of
physical exertion.
If the same task is carried out by workers of both sexes, it is useful to calculate a gender index, one
for males and one for females.
It is advisable to exclude workers with upper limb pathologies, and workers with less than one year's
working experience from the calculation of the average exertion index.
Furthermore, data supplied by the workers themselves should be excluded, when the figures are very
high, and if there is no real technical justification for the values chosen.
E x a m p l e 7.1 (Table 7.1)

With reference to Example 6.8 in Chapter 6, the average exertion weighted over time must be estimated
for the two tasks, welding the rod (A), and cutting the terminal hole (B). Many operators should be
interviewed for each one of the tasks, if available, so that the judgement on the average exertion required
is based on as many voices as possible.
Table 7.1 lists the average values obtained by the group of 4 workers according to the Borg Scale score
given to each action and the final weighted average exertion score.
Please note that in task B, in two actions, score 5 (strong) is used, which implies a duration roughly
equal to 20% of cycle time.
T a b l e 7.1 - ( E x a m p l e 7.1)
SUBJECTIVE EVALUATION OF PERCEIVED EXERTION WITH BORG'S SCALE
Line: ........................................................................................................................................................................................................................... Shift ...I e II...

Operations 9A) W E L D I N G A ROD ............................................................................. B) CUTTING A T E R M I N A L H O L E ........................................................................
WHICH ACTIONS MAKE YOU EXERT FORCE WITH YOUR HANDS OR ARMS? CAN YOU EXPLAIN THE REASONS?
TASK A . . . W E L D I N G O F ROD: S C O R E S O B T A I N E D F R O M 4 O P E R A T O R S ......
LIST OF ACTIONS SCORE %AGE DUR. | INDEX REASONS FOR THE

LIMB (*)
REQUIRING EXERTION OVER TIME ~ CALCULATED EXERTION OF FORCE
R L R L
L P I C K UP BOX 3 0.10 0.30 W E I G H S 3 KG AND
L TURN P I E C E 3 0.10 0.30 IS D I F F I C U L T
R G R A S P W I T H R I G H T HAND 2 0.'i0 0.20 TO G R A S P
R +L P O S I T I O N BOX 2 0.10 0.10 0.20 0.20
ALL REMAINING TIME RIGHT 0.5 0.80 0.40

ALL REMAINING TIME LEFT 0.5 0.70 0.35
AVERAGE EFFORT WEIGHTED
OVER TIME (E)
TASK B C U T T I N G A T E R M I N A L H O L E : A V E R A G E S C O R E S O B T A I N E D F R O M 4 O P E R A T O R S . . .
LIMB LIST OF ACTIONS SCORE %AGE DUR. INDEX CALCUL. REASONS FOR THE
REQUIRING EXERTION (*) OVER TIME R L EXERTION OF FORCE
BOX WEIGHS 5-6 KG
R G R A S P BOX 5 0.10 0.5 AND CONVEYOR
0.10 0.5 BELT IS VERY FAR

PUT BOX ON C O N V E Y O R BELT 5 FROM OPERATOR'S
BODY
ALL REMAINING TIME 0.80 0.80 -
AVERAGE EFFORT WEIGHTED 1
OVER TIME (E)
0 NOTHING AT ALL
0.5 VERY VERY WEAK (JUST NOTICEABLE) * Average score obtained, when possible, from more
1 WEAK operators carrying out the same task.
2 WEAK (LIGHT)
3 MODERATE
4
5 STRONG
6
7 VERY STRONG
8
9
10 VERY VERY STRONG (ALMOST MAX)
8. A N A L Y S I S A N D E V A L U A T I O N OF WORKING POSTURES
The postures, assumed by the various segments of the upper limb, and the movements executed during
repetitive tasks, are among the elements which contribute most to the risk of onset of various musculo-
skeletal disorders.
Currently, there is a sufficient degree of consensus in the literature towards the defining of the
following as potentially dangerous: extreme postures and movements of each joint, postures (even if not
extreme) maintained for a long period of time, and movements of the various segments which are
strongly repetitive (stereotypy).
An accurate description of posture and movements can also be considered as a predictive element of
specific pathologies of the upper limbs, which can be foreseen for exposed operators in the presence of
other risk elements (such as frequency, force, duration). Tables 8.1 and 8.2 (for the hand-forearm region,
and for the scapulo-humeral girdle respectively) illustrate the possible pathologies, again according to
specific postures and movements of the segments implied (Pheasant, 1991; Putz Anderson, 1988).
The description/assessment of the postures must be done over a representative cycle for each one of
the repetitive tasks examined. This must be via the description of frequency and duration of the postures
and/or movements of the four main anatomical segments (both fight and left):
a) posture and movements of the arm with respect to the shoulder (flexion, extension, abduction);
b) movements of the elbow (flexions-extensions, prono-supinations of the forearm);
c) postures and movements of the wrist (flexions-extensions, radio-ulnar deviations);
d) postures and movements of the hand (mainly the type of grip).
For assessment purposes, the different postures and movements can be classified according to the
degree of intrinsic postural involvement (absent, light, heavy). This classification becomes possible on
the basis of the existing indications in the literature, with paramount consideration being given to the
data on joint movement "ranges" for each movement of each joint.
Involvement should be considered as absent if the joint segment is in an neutral position, or is not
involved in working activities; it should be classified as light if the excursion is less than 40-50% of
joint range. For classification purposes, it is enough to see that, within the execution of every action, the
joint segment involved reaches an excursion greater than 40-50% of joint range (or is in an unfavourable
position for gripping with the hand) to classify the involvement as being heavy.
Heavy joint involvement is quantified with different scores (form 2 to 4) extrapolated from the data
on subjective joint involvement perception. The latter issue was decided also on the basis of subjective
studies (Genaidy et al. 1994), whereby the reciprocal order of perceived involvement was established
in relationship to each posture or movement of the main upper limb joints. One of the results, relating
to the wrist joint, is that movements of great extension are perceived as requiring much more exertion
68 RISK ASSESSMENT AND M A N A G E M E N T OF R E P E T I T I V E M O V E M E N T S A N D E X E R T I O N S OF U P P E R LIMBS
Table 8.1 - Postural risk factors for the wrist, the forearm and the elbow (Putz Anderson, 1988)
Functional requirement of task Type of pathology
Forced movements of wrist Wrist tendinitis

Repeated extensions of wrist and hands Epicondylitis
Repeated actions which "pull the sleeve" Tenosynovitis, de Quervain's s.
(flexion/extension of wrist, prono-supination,
grip with force)
Repeated radio-ulnar deviations with exertion of force Tenosynovitis, de Quervain's s.
Repeated prono supinations with ulnar deviation Tenosynovitis epicondylitis (cts)
of the wrist
Repeated gripping actions with flexed wrist Tenosynovitis of the long flexor of finger
Repeated flexions-extensions of the wrist, grip with force Carpal tunnel syndrome (cts)
and/or precision
Prolonged pressure on elbow, when it is flexed Entrapment of ulnar nerve at elbow
Repeated exertion of force with hand, with extended wrist Entrapment of ulnar nerve at wrist
Use of tools requiring radial deviation of wrist, Epicondylitis
if combined with extension and pronation
Use of tools which must be "triggered", if handle Tenosynovitis of the flexors
is large enough to cause extension of proximal
inter-phalangeal joints
Table 8.2 - Postural risk factor for the scapulo-humeral girdle (Putz Anderson, 1988)
Functional requirement of task Type of pathology
Adduction/abduction/flexion movements of the arm, Shoulder tendinitis, or rotator cuff syndroms

exceeding 180 ~
Keeping the arm elevated at a height equal to,
or exceeding that of the shoulders
Transporting weights with the shoulder
launching objects (sudden movements)
Transporting heavy loads with hands Outlet thoracic syndrome
(supported by upper limbs)
Transporting weights with straps tied to shoulders
Hyper-extension of arm
Working with arms high above head
(white-washing of walls, etc.)
than those in radial or ulnar deviation (those in flexion are intermediate). Another issue that emerged is
that all relevant scapulo-humeral joint movements are perceived as being highly exertive, in the same
way as wrist extensions are.
Table 8.3 refers to the main joints of the upper limbs, and summarizes the degrees beyond 40-50%
of joint excursion range and the relative score, which has been weighted with respect to subjective
perception:
ANALYSIS AND EVALUATION OF WORKING POSTURES 69
Table 8.3 - Degrees beyond 40-50% of joint excursion range and relative score
Scapulo-humeral joint ABDUCTION (+45 ~ = SCORE 4

(shoulder) FLEXION (+80 ~ = SCORE 4
EXTENSION (+20 ~ = SCORE 4
Elbow joint SUPINATION (+60 ~ = SCORE 4
PRONATION (+60 ~ = SCORE 2
FLEXION-EXTENSION RANGE (+60 ~ = SCORE 2
Wrist joint EXTENSION (+45 ~ = SCORE 4
FLEXION (+45 ~ = SCORE 3
RADIAL DEVIATION (+15 ~ = SCORE 2
ULNAR DEVIATION (+20 ~ = SCORE 2
As far as the types of hand grip are concerned, some of them (pinch, upper palmar grip, etc.) are
considered as being less favourable with respect to the grip, and are therefore classified as implying
medium/high involvement. In consideration of this, the involvement score of the different type of hand
grasp has been classified according to the Table 8.4.
Figure 8.1 shows the main joint movements which are included in the analysis, together with the
main types of hand grip.
As pointed out previously, such analyses mandatorily require the use of an adequate film, which must
be studied in slow motion. To simplify posture analysis, which is possibly the most complex job among
the procedures of exposure assessment, it is possible to use simplified forms which show the most
relevant movements and postures of the segments under examination. The model illustrated in Figure
8.2 is suitable and can be used to this end.
Once postural involvement has been assessed, it is necessary to estimate the durations of the different
types of involvement of all the segments examined - these must be expressed with relationship to the
duration of the single cycle and, consequently, to the duration of the task. In the analysis and description
model which is suggested in Figure 8.2, the Authors have tried to make all the concepts heretofore
expressed as simple and practical as possible for application in the field.
Four separate operating phases are foreseen in the form presented in Figure 8.2:
a) the description of the postures and/or movements, done separately for the joints: scapulo-humeral,
elbow, wrist, hand (type of grip and finger movements), right and left respectively;
b) establishing if there is joint involvement (high), and its timing within the cycle (1/2, 2/3, 3/3 of cycle
time);
Table 8.4- Involvement scores of hand grip
- WIDE GRIP (4-6 cm) = SCORE 1

- TIGHT GRIP (1.5 cm) = SCORE 2
- FINE FINGER MOVEMENTS = SCORE 3
- PINCH = SCORE 3
- PALMAR GRIP = SCORE 4
- HOOK GRIP = SCORE 4
70 RISK ASSESSMENT A N D M A N A G E M E N T OF R E P E T I T I V E M O V E M E N T S AND E X E R T I O N S OF U P P E R LIMBS
Figure 8.1 - Principal upper joint movements and principal hand grips
SHOULDER POSITIONS AND MOVEMENTS
ELBOW MOVEMENTS
WRIST POSITIONS AND MOVEMENTS
TYPES OF HAND GRIPS

Figure 8.2
TASK 9 DR DE
Z RISK
0 SCORE IN
CYCLE
O~
~Z
[A1] MOVEMENTS IN RISK AREAS:

<~
[A2] LACK OF VARIATION (STEREOTIPY):
carries out working gestures of same type, involving the shoulder, for at least 50% of cycle time:
[A3] KEEPS ARMS UPLIFTED (not supported) in risk areas:
1/3, ~ 2/3, ~ 3/3 of cycle time
I I I
[A4] KEEPS ARMS UPLIFFED (not supported) by over 20 ~ or in extension for at least 50% of cycle time: ['~
SHOULDER
~0 EXCURSION OF AT LEAST 60~

Zm
Z~ m
! I I
[B1] MOVEMENTS INRISKAREAS" F4-] 1/3, ['ff'] 2/3, ~ 3/3 supination 1 ELBOW
THEY OCCUPY: E] 1/3, ~ 2/3, ~ 3/3 pronation j. of cycle time
0 ['~ 1/3, IT] 2/3, 1"~ 3/3 flexion
[B2] LACK OF VARIATIONS"
carries out the same type of gestures and movements involving the elbow for at least 50% of cycle time:
, ,
2;
I I I
O WRIST
~>
~O [C1] MOVEMENTS IN RISK AREAS: ~ 1/3, r ~ 2/3, ~ 3/3 R/U deviation }
o~ (OR MAINTENANCE) TAKES UP: 1/3, ~ 2/3, 3/3 extension of cycle time
1/3, ~ 2/3, 3/3 flexion
[C2] LACK OF VARIATION 9
carries out working gestures of same type, involving the writs for at least 50% of cycle time:
[--, [D1] GRIP TIME AND FINGER POSITION

2; [ ] GRIP (3-4 CM) [1] 1/3, [2] 2/3, [3] 3/3
[ ] TIGHT GRIP (1,5 CM) [2] 1/3, [4] 2/3, [6] 3/3
[ ] PINCH [3] 1/3, [6] 2/3, [9] 3/3
[ ] PALMAR GRIP [4] 1/3, [8] 2/3, [12] 3/3
r~
[ ] HOOK GRIP [4] 1/3, [8] 2/3, [12] 3/3 I I I
[ ] DIGITATION [4] 1/3, [8] 2/3, [12] 3/3 ? of cycle time
O GRIP/HAND
[ ] .......................... [2] 1/3, [] 2/3, [ ] 3/3
[ ] .......................... [] 1/3, [] 2/3, [ ] 3/3
[ ] .......................... [] 1/3, [] 2/3, [ ] 3/3
LACK OF VARIATION: '~
[D2] carries out working gestures of same type, involving the same
Z finger for at least 50% of cycle time: [T]
<
[D3] keep an object continually for at least 50% of cycle time: I'T]
, | , ,
c) establishing the presence of stereotypy of certain movements or maintenances (i.e., joint movements
of the same type, independent of the range), which can be pinpointed by observing technical actions,
or groups of technical actions which are all equal to each other for at least 50% of cycle time; static
positions which are maintained the same for at least 50% of cycle time, that is, of very short duration
(less than 15 seconds), but obviously characterised by the presence of actions of the upper limbs.
Example 8.1
Assembly of a given product requires, among other actions, the positioning of 10 screws in the
respective holes. For every screw to be positioned, 3 technical actions are required, i.e., grasping the
screw, putting it in the hole, turn the screw once: these 3 actions are defined as a group of technical
actions which will repeat themselves many times, always equal to each other, therefore leading to the
presence of stereotypy.
d) Calculation of the overall involvement score within the cycle taken as representative of the task (for
each joint and for each arm).
All 4 phases indicated will be analysed in detail, and subdivided by joint segment.
PHASE 1) description of posture and movements of the scapulo-humeral joint.

A cycle should be carefully observed by reviewing the film in slow motion. All movements and
postures of the arm with respect to the shoulder must be described. The form includes drawings which
show the areas "at risk" which are reachable by abduction movements (>45~ flexion movements
(exceeding 80~ extension movements (exceeding 20~ Measurements supplied have been selected by
rounding off the analytical values found in literature, and by supplying figures which are more easily
identifiable during direct observation without the need of employing dedicated tools (i.e. goniometer).
The foreseen risk score attributed is 4 if the movements in risk areas occupy 1/3 of the cycle; it is 8 for
2/3; and it is 12 for 3/3 of the cycle (A1).
It must furthermore be pointed out if the operations in the cycle include:
- the carrying out of the same technical actions, or group of technical actions, involving the shoulder
(independently of the joint range) for at least 50% of cycle time (A2);
- keeping the arm uplifted in risk areas for 1/3, 2/3, 3/3 of cycle time (A3),
- keeping arms unsupported (greater than 20 ~ in general) for at least 50% of cycle time (A4).
Example 8.2
For 2/3 of cycle time (and of the task within the shift) the operator, after having picked up a handful of
screws, must slip them, with his/her fight hand, into the operating point, which is at the height of the
shoulder. During the remaining 1/3 of the time, he/she must pick up the screws from a container which
is positioned laterally, and rather high, with respect to the trunk.
In this case, the risk score will be 16 (which is the maximum score obtainable), because for 11/3 of
the time the operator moves in abduction for over 45 ~, for 2/3 of the time he keeps the arm bent over
80 ~ (in risk area), and the latter position is maintained consecutively for over 50% of cycle time
(stereotypy).
Figure 8.3 - (Example 8.2)
RISK
RIGHT SCORE IN
CYCLE
Z
9
[-.,
[A1] MOVEMENTS IN RISK AREAS: OCCUPY: ['~ 1/3, [8-] 2/3, ~ 3/3 of cycle time
[A2] LACK OF VARIATION (STEREOTYPY):
1 6
Z~ carries out working gestures of same type, involving the shoulder, for at least 50% of cycle I I I
time: SHOULDER
1/3, ~ 2/3, ~ 3/3 of cycle time
[A4] KEEPS ARMS UPLIFTED (not supported) by over 20 ~ or in extension for at least 50% of
cycle time: [ ~
Example 8.3
The operator picks up a handful of screws from the container on the workbench (72 cm) near his/her
body, for 1/3 o f the time, then slips the s c r e w s on the s u p p o r t w h i c h is p o s i t i o n e d j u s t a little h i g h e r u p
(the a r m s are slightly f l e x e d a n d a b d u c t e d by 20 ~ and are u n s u p p o r t e d ) for the r e m a i n i n g 2/3 o f the time.
RISK
RIGHT SCORE IN
Z CYCLE
9
[A1] MOVEMENTS IN RISK AREAS" OCCUPY: ~ 1/3, ~ 2/3, ~ 3/3 of cycle time
carries out working gestures of same type, involving the shoulder, for at least 50% of 0 4
cycle time: ~ I I I
SHOULDER
[ ~ 1/3, 8 2/3, 12 3/3 of cycle time
[A4] KEEPS ARMS UPLIFTED (not supported) by over 20~ or in extension for at least 50%
of cycle time: ['~
The operator carries out the same operations which are described under example 8.2, but the position
of the arms never reaches the risk areas. It must be pointed out that the arms are unsupported (when
above 20 ~ for at least 50% of the time: the score 4 is due to the presence of stereotipy in maintaining
the posture with the unsupported arms.
PHASE 2) description of the movements of the elbow joint.

Figure 8.5, the figure on the left illustrates all the areas which are "at risk" for pronation and
supination movements (exceeding 60~ A second figure shows the areas "at risk" for movements of
flexion-extension of the elbow (exceeding 60 ~ of overall excursion, independent of starting position).
Description is only foreseen for movements, and not for "maintained" positions, both for
pronosupination and for elbow flexion ranges. For the elbow, in fact, a maintenance position (e.g.,
flexed elbow, or pronated wrist) can even be a resting position. In the case of movements towards
maximum pronation of the elbow, the suggested score is 2 (medium involvement), and not 4 (maximum
involvement), because during any normal working activity the operator will obtain complete pronation
of the hand on the workbench via a partial intemalrotation of the shoulder. The position of shoulder
internalrotation is nearly always present, but it is difficult to notice for a company technician. Maximum
supination has a high involvement score (score 4) for elbow structures, while exceeding the flexural
range presupposes an average involvement (score 2).
It is also necessary to describe whether the same working gesture involves the elbow for at least 50%
of cycle time, independent from the joint range.
Example 8.4
This example continues the description of the operator who takes a handful of screws and puts them in
a position at shoulder height (example 8.2). Attention focuses on the elbow (the fight elbow in
particular). After having picked up the handful of screws with the fight hand (in pronation), the operator
executes repeated complete pronations every time he puts a screw in its hole (1/3 of cycle time); he
repeatedly returns to position zero of the wrist, which enables him to slip a new screw from the palm of
his hand to the tip of his fingers (1/3 of cycle time).
Since the point where the screws are picked up is far from the body and so are the holes where the
screws must be positioned, the elbow must carry out a wide flexion-extension movement for not less
than 1/3 of the time (score 2). Repetition of the same technical actions (pick up and position screws) for
at least 50% of the time adds the presence of stereotypy (score 4). The total risk score is therefore 8
(Figure 8.5).
Stereotypy (score 4), and pronations are always present, but flexion of the elbow is no longer present,
so the final score is now 6 (Figure 8.6).
ANALYSIS A N D E V A L U A T I O N OF W O R K I N G POSTURES 75
RIGHT
II II
I I I
ELBOW
[B1] MOVEMENTS IN RISK AREAS: ~ 1/3, [-8] 2/3, ~ 3/3 supination ]

THEY OCCUPY: [~] 1/3, ~ 2/3, [6] 3/3 pronation i' of cycle time
[~ 1/3, ~ 2/3, ~ 3/3 flexion
[B2] LACK OF VARIATIONS 9
carries out the same type of gestures and movements involving the elbow for at least 50% of
cycle time: ['~
Example 8.5
Example 8.3 is referred to once again, and a description of elbow involvement is drafted. The operator
is still putting screws in holes for 2/3 of cycle time, but the operating points are now close to the trunk.
Figure 8.6- (Example 8.5)
RIGHT
0 6
I,~ I .... I
ELBOW
[B1] MOVEMENTS IN RISK AREAS: ~ 1/3, l-g] 2/3, ~ 3/3 supination ]

THEY OCCUPY: ~ 1/3, ~ 2/3, ["6] 3/3 pronation I of cycle time
I~] 1/3, ~ 2/3, I-if] 3/3 flexion
[B2] LACK OF VARIATIONS 9
carries out the same type of gestures and movements involving the elbow for at least 50% of
cycle time: ['4]
PHASE 3) description o f the posture and movements o f the wrist.

Figure 8.7, the figure on the left describes areas "at risk" for flexion and extension
postures/movements (beyond 45~ The second figure describes areas "at risk" for radio-ulnar
deviations, which may appear concurrently with the flexions-extensions (15 ~ for radial deviations, 20 ~
for ulnar deviations) (C1). Similarly to what happens for the shoulder, it is necessary to describe
whether the cycle includes the following"
- the same working gesture, involving the wrist for at least 50% of cycle time (C2);
- maintaining the wrist in a position of ulnar or radial deviation (exceeding 15~ or in flexion-
extension (exceeding 45~ for at least 1/3 of cycle time (C1);
- keeping the wrist flexed or extended, or deviated (ulnar or radial), continuously for at least 50% of
the time (C2).
For extensions exceeding 45 ~, considered at "high risk", the score is 4, for flexion it is 3, for radio-
ulnar deviations it is 2.
E x a m p l e 8.6
Example 8.2 is taken up, and involvement of the wrist is accurately described.
Since the point in which the operator puts the screws in the holes is rather high up and far from the body,
the operator is forced to flex the wrist for 2/3 of the time, and is also called upon to execute occasional
ulnar deviations: the latter account for 1/3 of cycle time. There definitely is stereotypy.
The overall score is 12. The position where the screws are picked up does not imply awkward postures
for the operator wrist (Figure 8.6).
Figure 8. 7 - (Example 8.6)
r.,r
[-., SLIP THE SCREWS
z
1 2
I I I
WRIST
[..,
EXTENSION FLEXION RADIAL ULNAR
DEVIATION DEVIATION
9 [C1] MOVEMENTS IN RISK AREAS: ~3 1/3, i'~ 2/3, ~ 313 R/U deviation]
t-,.4
b-, (OR MAINTENANCE) TAKES UP: [4] 1/3, [8] 2/3, ~ 3/3 extension ~ofcycle time
9 ~ 113, ['~ 213, ~ 313 flexion J
[C2] LACK OF VARIATION:
carries out working gestures of same type, involving the wrist for at least 50% of cycle time:
N
ANALYSIS A N D EVALUATION OF W O R K I N G POSTURES 77
E x a m p l e 8.7
Example 8.3 is taken up, and the wrist joint is analysed.
The operator can put the screws in their holes at workbench height (roughly). The wrist is called upon
to carry out small flexions, which do not go anywhere near the "risk areas". Ulnar deviation movements
are present for 1/3 of the time, and there is stereotypy (movements of the same type for at least 50% of
cycle time). The overall risk score is 6 (Figure 8.8).
z
0 6
I I
WRIST
EXTENSION FLEXION RADIAL ULNAR

DEVIATION DEVIATION
[C1] MOVEMENTS IN RISK AREAS: [~l 1/3, ~ 2/3, ~ 3/3 R/U deviation]
(OR MAINTENANCE) TAKES UP: ~ 1/3, I-8] 2/3, ~ 3/3 extension ~fcycle time
r~ ['3"] 1/3, ['~ 2/3, ~ 3/3 flexion j
9
[c21 LACK OF VARIATION:
carries out working gestures of same type, involving the wrist for at least 50% of cycle time:
gl
PHASE 4) description of the posture and movements of the hand.

Considering the great complexity and variability which can be observed, both in terms of postures
and of movements, a simplification was decided upon" it gives priority to the description of the grasping
positions: WIDE GRIP (light involvement: score 1); TIGHT GRIP (medium involvement: score 2);
PINCH (medium/high involvement: score 3); PALMAR GRIP AND HOOK GRIP (high involvement:
score 4). The presence of fine finger movements is indicated as medium/high involvement (score 3, see
Figure 8.9).
It is also necessary to describe whether the same technical actions also involve the hand joints with
the same type of grip (pinch, palmar grip, hook grip), or with any other movement, for at least 50% of
cycle time. With reference to this specific observation, it is also necessary to indicate the presence of
specific activities, even if they only involve one finger (D2 and D3).
Example 8.8
This example describes the type of hand grip during the picking up of the screws and placing them in
their holes (examples 8.2 and 8.3).
78 RISK A S S E S S M E N T A N D M A N A G E M E N T O F R E P E T I T I V E M O V E M E N T S A N D E X E R T I O N S O F U P P E R LIMBS
[D1] GRIP TIME AND FINGER POSITION
[ ] GRIP (3-4 CM) [1] 1/3, [2] 2/3, [ 3 ] 3/3

[ ] TIGHT GRIP (1,5 CM) [2] 1/3, [4] 2/3, [ 6 ] 3/3
[--,
[] PINCH [3] 1 / 3 , ~ i ~ [ 9 ]3/3
Z 1 2
[ ] PALMAR GRIP [4] 1/3, [8] 2/3, [12] 3/3
I I I
[] HOOK GRIP [4] 1/3, [8] 2/3, [12] 3/3 of cycle time HAND GRASP
[] DIGITATION [4] 1/3, [8] 2/3, [12] 3/3
[ ] HANDFUL OF SCREWS ~ , [ ]2/3,[ ]3/3
[] .......................... [ ]1/3,[ ]2/3,[ ]3/3
[] .......................... [ ]1/3,[ ]2/3,[ ]3/3
z LACK OF VARIATION:
<
[D2] carries out working gestures of same type, involving the same finger
for at least 50% of cycle time: ['4]
[D3] keep an object continually
for at least 50% of cycle time: [~]
Picking up a handful of screws (1/3 of the cycle time) implies a type of grip which is definitely
different from the wide grip, but that can, to a certain extent, be considered similar: for this reason, score
2 is considered reasonable (Figure 8.9).
Generally speaking, when the operator's grip is different from the types described here, it is advisable
to choose a score which may vary from 1 to 4 (it must always be referred to the fraction of cycle time),
according to the similarities with the other types of grip indicated.
As for fine finger movements, this means all the finger movements present in a task and which are
necessary to obtain operational results cannot be described as independent movements.
Example 8.8 (cont.d)

When putting the screws in their holes, the operator uses, for 2/3 of the time, a pinch grip (score 6).
There is stereotypy, as in any repetitive task.
The final score is 12 (Figure 8.9).
Last, but not least, the postural analysis scheme model is taken up again. It is entirely filled in as far
as occupational exposure described in example 8.2 is concerned (positioning of screws with uplifted
arm). The joint which is involved most heavily is the shoulder, with the highest possible score (score
16), followed the by joints of wrist and hand (the latter including the presence of pinch grip), both with
a score of 12 (Figure 8.10). Figure 8.11 summarises postural analysis for the same operation, but with
the screw loading support now at workbench level. In this case, the operator can work with his arms
close to the workbench, and therefore there is an improvement in the risk indexed in almost all joint
segments, excluding the hand, because the type of grip is perforce unchanged (pinch grip).
ANALYSIS A N D EVALUATION OF W O R K I N G POSTURES 79
For evaluating postures (as for all the risk factors taken as a whole) it is also possible, as previously
mentioned, to use a different form.
Table 8.5 reprises example 8.2, this time completing it with an assessment of action frequency and
of force, for both upper limbs.
Action frequency within a 16 second cycle is equal to 16 actions for the right and one for the left. In
fact, the left limb only holds the support still (with the hand in palmar grip), while the right puts the
screws in. There is no exertion of force, if not extremely light (0.5 of Borg's Scale).
For the description of the static maintenance posture, use the symbol "O". It is always best to use two
forms, one for the fight and one for the left.
If the actions, or the retained postures, are repeated, it is useful to indicate their number in the boxes
which describe the posture (for ex., 3, or 4), or their duration in terms of the fraction of cycle time which
they occupy, if the time during which the maintenance posture is retained is lengthy (for ex., 2/3 of cycle
time).
To find out how much the overall duration of actions implying awkward postures is within the cycle,
it can be postulated that every technical action (actions implying movements) has the same duration.
By examining the column referring to postural analysis, the vertical part refers to the counting of
actions which refer to the column. If the total number of the actions in the cycle is known, it is easy to
determine, as a fraction of the total, what proportions are occupied by a given awkward posture.
Figure 8.10 - Inserting screws on a high support (ex. 2) which is far from the trunk
TASK. " DR DE
Z RISK
9 SCORE IN
CYCLE
mZ
~m

[A3] KEEPS ARMS UPLIFTED (not supported) in risk areas: 1 6
1/3, ~'] 2/3, ~ 3/3 of cycle time
N I I I
[A4] KEEPS ARMS UPLIFFED (not supported) by over 20~ or in extension for at least 50% of cycle time: [ ~ SHOULDER
Z~ EXCURSION OF AT LEAST 60~

0 8
I I I
[B1] MOVEMENTS INRISKAREAS" ~ 1/3, ['ff] 2/3, ~ 3/3 supination 1 ELBOW
THEY OCCUPY: ~2"] 1/3, [4"]2/3, ['~ 3/3 pronation J of cycle time
[~ [T]I/3, 2/3, I'~ 3/3 flexion
[B2] LACK OF VARIATIONS:
carries out the same type of gestures and movements involving the elbow for at least 50% of cycle time: I~
1 2
I I I
WRIST
[C1] MOVEMENTS IN RISK AREAS: ~ 1/3, ~ 2/3, ~ 3/3 R/U deviation )
(OR MAINTENANCE) TAKES UP: 1/3, 2/3, 3/3 extension of cycle time
1/3, 2/3, 3/3 flexion
[C2] LACK OF VARIATION:
[D1] GRIP TIME AND FINGER POSITION

[-
Z [ ] GRIP (3-4 CM) [1] 1/3, [2] 2/3, [3] 3/3
[ ] TIGHT GRIP (1,5 CM) [2] I/3, [4] 2/3, [6] 3/3
[ ] PINCH [3] 1/3, ~ [9] 3/3
1 2
[ ] PALMAR GRIP [4] 1/3, [8] 2/3, [12] 3/3
[ ] HOOK GRIP [4] 1/3, [8] 2/3, [12] 3/3 I I I
of cycle time
9 [ ] DIGITATION [4] 1/3, [8] 2/3, [12] 3/3 GRIP/HAND
[ ] HANDFUL ............ (~~ [] 2/3, [ ] 3/3
[ ] .......................... [] 1/3, [ ] 2/3, [ ] 3/3
[--, [ ] .......................... [ ] 1/3, [ ] 2/3, [ ] 3/3
LACK OF VARIATION: J
Z finger for at least 50% of cycle time: ITI
<
[D3] keep an object continually for at least 50% of cycle time: I~1
Figure 8.11 - Fitting screws on support on workbench (ex. 8.3) close to the trunk
TASK. 9 DR FIE
Z RISK
9 SCORE IN
CYCLE
~Z
[A1] MOVEMENTS IN RISK AREAS"

0 4
1/3, ~ 2/3, ~ 3/3 of cycle time
D I I I
[A4] KEEPS ARMS UPLIFIED (not supported) by over 20 ~ or in extension for at least 50% of cycle time:
SHOULDER
Z~ EXCURSION OF AT LEAST 60~

0 6
! I
[B1] MOVEMENTS IN RISKAREAS" [ ~ 1/3, ['ff] 2/3, ~ 3/3 supination ] ELBOW
THEY OCCUPY: ~'2] 1/3, [Ti 2/3, ['6] 3/3 pronation j, of cycle time
0 ['2] m l / 3 2/3, [-8] 3/3 flexion
[B2] LACK OF VARIATIONS:
0 6
I I I
WRIST
[C1] MOVEMENTS IN RISK AREAS: ~ 1/3, IT[ 2/3, ~ 3/3 R/U deviation }
0 0 (OR MAINTENANCE) TAKES UP: 1/3, ["8] 2/3, 3/3 extension of cycle time
1/3, ~ 2/3, 3/3 flexion
carries out working gestures of same type, involving the writs for at least 50% of cycle time: [ ~
[--, [D1] GRIP TIME AND FINGER POSITION

Z [ ] GRIP (3-4CM) [1] 1/3, [2] 2/3, [3] 3/3
[ ] TIGHT GRIP (1,5 CM) [2] 1/3, [4] 2/3, [6] 3/3
[ ] PINCH [3] 1/3, ~ [9] 3/3
[ ] PALMAR GRIP [4] 1/3, [8] 2/3, [12] 3/3 1 2
[ ] HOOK GRIP [4] 1/3, [8] 2/3, [12] 3/3 I I I
[ ] DIGITATION [4] 1/3, [8] 2/3, [12] 3/3 of cycle time
9 GRIP/HAND
[ ] ~IANOFUL ............ ~ [ ] 2/3, [ ] 3/3
[ ] .......................... [] 1/3, [ ] 2/3, [ ] 3/3
[ ] .......................... [] 1/3, [ ] 2/3, [ ] 3/3
LACK OF VARIATION" '~
Z finger for at least 50% of cycle time: [~l
<
[D3] keep an object continually for at least 50% of cycle time:
82 RISK ASSESSMENT A N D M A N A G E M E N T OF REPETITIVE M O V E M E N T S A N D E X E R T I O N S OF U P P E R LIMBS
Table 8.5
I s'r SHIFT OR SINCd.E SlIlFT 2m SHIFt

I I I I I I I I II i'! I ! I I.,I ! i I
................................................................................. I ~ IUSK SCOglI~ 4
,~.~us m a c y 0bOnG) msn~ Asp

NCY SHOULDF.R MOV]~[I~rIS
DES(~IUPTION O F U P P E R LIMB MOVEMENTS !
TECHNICAL ACTIONS
RIGHT LEFT
(omsidering left and right sides separately) xtim= xtime
I ~ I M P H A N D F U L O F S C R E W S (lq.,VNOg HAND INTO CONTAINER

l q L L O F S C R E W S : 3 4 ACTIONS O B S E R V g D T O F I L L HAND
E ,
[_!1~i~ 9 ~3UgWS GRASP 6
J.~r~ww~ INSKRT ,
J . . . .
R L 2 MOVINO OR IdAJI]~AINING ~ JOINT

16 16 60 430 25800 U~IV]DUAL JOINTS IN ~ MOVEMmNTSlq31t ~tClJ~
"BORG" I~DsrIIONS POP.: TIMES OF:
X60:
CYCLE CYCLE NET No.ACTIONS VALUES
FREQUENCY TIME FREQUENCY OPERATION INSHIFT
(MINUTES) TIME MULTIPLU~
INSHIFT B Y TIME r~~. wn~ ~ ~.Nm I~lmmo~
FRACTION rrl,,~ 9 I~lm eXT.
OF
DURATION
~ ~ ' L
X 60 : CYCLE X NET m No.ACTIONS
~FREQUENCY TIME FREQUENCY OPERATION INSHIFT
(MINUTES) TIME 9 $ MAINTAINS ARMS ~ : CONTINUOUSLY IN~ AT
I INsmFT mlt _.__L CONTINUOUSLYAT OVId. LIP.AST~)ql~( ~ T'I~
BXEirrlON I[,~GSRTION 20" POR AT LIlAST ~,0'1,OF
SCORB SCOM TH~CYCL.ETIM~ ~ ' l I O R
i 6
S H ~ ~ R 0 8
SCORE I~L.BOW R
~ L
L
~ A N D ~ 14)STURE AND BAND MOVlgMBNTS ADDmON.t_L FACTORS

M O ~ l
4
~ , ,.
!
I' x 6 X
6 X
i 6 6 X
MOVING OR MAINTAI/m~ ~ m T S IN 'GmPTU~ANDo m ~ ~ msmo~: ANY ADDgrlONAL FACTORINDr_ATED POll

EXTREMBPoSmONS FOR CYCLE CYCLE PERIODS:
T I M ~ OF: Elm. ~ m . B m ~ o ~
~'~. m ~. N ~ ~ o ~ OR~~ , , ~ ~ , ~ lrlm. I!gm NI ~
~"~. ~!~. N ~ ~ ~
IN)R OTHERS THE PdSK SCOR~ MAY RAN(~ l~tOM I TO4.
~ :~. rrl m. [!] ~ u~,,o~,
I~V.
IEm. IXIm. I!im
b"lm. [Elm. Imm ,mOxoRn, Elm. ,Tim. [ ] m

MAilh'rAINS ~ I~'dSED m ~ o ~ s SOM~MOVeU~TSORuxucr,.u~ss~.,,u3,~srno~ ~ D o m o N ~ I:ACrOR SCORE
~ S L Y AT20" AISLE FOR CONTINUOUSLY FOR AT LEAST S0% OF THE CYCLs TEME: ~ ] R [~] L
RLF.AST~,0~ OF 11U~CYCLE TIMF.:
12
HAND ~ R
WRIST [~ L SCOP~
SCORE ] L
9. DEFINITION AND QUANTIFICATION OF ADDITIONAL RISK FACTORS
Side by side with the risk factors which have already been examined, there are others to be found in the
literature, always of an occupational nature, that must be taken into consideration when exposure is
assessed. They are defined here as additional. This is not because they are of secondary importance, but
because each one of them can, from time to time, be present or absent in the contexts examined.
The list of these factors is not necessarily exhaustive and includes:
a) the use of vibrating tools (even if only for part of the actions);
b) requirement for absolute accuracy (tolerance 1-2 mm in positioning a piece or object);
c) localized compressions on anatomical structures of the hand or of the forearm with tools, objects, or
working areas;
d) exposure to cold or refrigeration;
e) the use of gloves which interfere with the handling ability required by the task;
f) objects handled have a slippery surface;
g) sudden movements, or tearing, tipping movements, or fast movements are required;
h) the working gestures required imply a countershock (such as e.g., hammering, or hitting with a pick
over hard surfaces, using the hand as a tool, etc.).
This list is only concerned with factors of a physical or mechanical nature; other factors, which are
listed under the general term of psycho-social, have also been called into play for determining the onset
of WMSDs. Among them, some are concerned with the individual sphere, and cannot therefore be
included in methods considering a collective and occupational type of exposure of a given group.
Conversely, there are factors which are definable as organisational (working pace determined by
machine, working on moving object, working by incentive, insufficient training), which should be taken
into consideration, at least from the descriptive point of view. They are not considered within this
specific assessment procedure, because of the difficulties implicit in their quantification.
The description of physical-mechanical additional factors can take place in parallel with that of
postures, by using the same information supports (e.g., filming the tasks). For each of the factors, it is
necessary to specify for how much time the factor is present (with respect to cycle time and to task
time), or to describe the frequency of occurrence of actions where that factor is present (especially for
sudden movements and movements with shock).
The exception is the factor defined as vibrations, where exposure assessment is governed by strict
estimation procedures. Apart from this exception, the assessment begins with a definition of optimum
conditions, as represented by the absence, or by the very limited presence, of additional factors: any
discrepancy with respect to those optimal conditions represents a contribution of additional factors to
the overall exposure level, which grows with the growing number of additional factors present.
84 RISK ASSESSMENT A N D M A N A G E M E N T OF R E P E T I T I V E M O V E M E N T S A N D E X E R T I O N S OF U P P E R LIMBS
For organisational additional factors one has to describe if they are present; when present (one or
more) they influence the whole task (3/3 of cycle time).
The detection system presented in Table 9.1, which was previously described in Chapter 8, contains
a descriptive and assessment model of additional factors. The most frequent ones are listed; others can
be added ad hoc, if they are observed in the task under examination.
For every additional factor indicated, the same risk score was assigned (score = 4). It is also possible
to assign variable scores to other additional factors (scores 1 to 4), according to the type of risk which
is presented.
If other additional factors are present (e.g., gloves, extreme temperatures, etc.), it becomes necessary
to assign a more specific score with every specific occurrence (score 2 to 4), to better represent the
actual risk in that specific situation. For instance, the kind of gloves used according to the type of task
carried out will influence the choice of different risk scores (e.g" accurate task with gloves which are
more, or less, adequate).
Similarly to the assessment of postural involvement, the risk due to the presence of additional factors
is summarised with a single code.
Example 9.1
When observing a cycle, it is simple to find out whether additional risk factors are present for 1/3, 2/3,
or 3/3 of cycle time. If they are only present for 1/3 of the time, tick the first box (value 4); if for 2/3 of
cycle time, tick the second box (value 8); if they are present for the whole of cycle duration, then tick
the third box (value 12). The value chosen is the final exposure score.
For example, an operator holds a vibrating tool which causes localized compression of the palm of his
hand. He uses the vibrating tool for 1/3 of cycle time, and for that same period he has "localized
compression".
Hence,
VIBRATIONS [4] 1/3, [8] 2/3, [121 3/3

COMPRESSIONS [41 1/3, [81 2/3, [121 3/3
The total score will be 8.

DEFINITION AND QUANTIFICATION OF ADDITIONAL RISK FACTORS 8 5
Table 9.1
3 '~SHIFT
I I I I l i I I I i,,~,--,,,~~176
RISK SCORE
Po,m't,~J~ AND ]SANDM O ~ M z m ~
io i ~i
iMOV1NOORMAINTAININOJOINTS GRIPTIMEFOROTHERFINOERPOSITIONS: FOR ANY ADDITIONAl. FACTOR INDICATED ~ CYCLE

IN EXTREMEI~OSI']IONSP(~CYCLE Iq~ODS:
TD4ESOF:
irlm. I!g~ IN ~
I/3. 2/3. 3#3 ~ U P WIDE
IIV.
~]lr3, 0[]2/3 ~ ] ~ J PALMARGIUP
[1~ I!l ~ , m ~ o N
,I~FORMS SAM~ M O ~ OB I ~ U ~ I U ~ SOMB M O V E N ~ OR MAINI'AII~ SAI~ lq~lqllON

'MAI~I'AI~S AItMS ItAlID ADDnl(~AL FACTOR SCOItE R
~ S I , Y A T 2O* A ~ 3 ~ B FOlt L
.ATI..EAs'r~Ik (~ TI~ CYCLETIM~ L
I liiA.~ I R
NL SCORE
L
WRIST R
10. A N A L Y S I S A N D E V A L U A T I O N O F R E C O V E R Y PERIODS
Introduction
A recovery period is a period during which one or more muscle-tendon groups are basically at rest,
while they would normally be involved in their habitual working tasks.
The following can be considered as recovery periods:
a) pauses from work (both official and non-official), including the lunch break where it exists;
b) periods during which the working tasks carried out leave the muscles previously employed in other
tasks at rest (e.g., visual control tasks, or tasks which are carried out, alternatively, with one of the
two upper limbs);
c) periods within the cycle that leave muscle groups previously employed in tasks totally at rest. These
rest periods (control/waiting), to be considered as significant, must be consecutively experienced for
at least 10 seconds almost every few minutes.
The analysis of recovery periods must therefore, first and foremost, check whether such periods are
actually present in the cycle (and, with what duration and distribution); then, their presence, duration
and frequency within the whole of the working shift can be examined more macroscopically.
With the partial exception represented by recovery times referring to actions which imply protracted
static contractions (please see further on), the description/evaluation of recovery periods should be
based on the following points:
a) description of the actual sequences of tasks with mechanical overload of the upper limb, description
of non-repetitive tasks and of pauses;
b) frequency and duration of recovery periods within the cycle (if they exist), and within the shift.
No univocally defined criteria exist in the literature for the evaluation of recovery periods. Bystrom's
contribution (1991) is very important, and formulates models for the planning of optimum work/rest
ratios in cases where intermittent static muscle actions are involved.
Unfortunately, there is still a lack of precise and scientifically proven guidelines concerning recovery
periods after repetitive dynamic actions, which represent the majority of working contexts.
One useful, albeit empirical indication on the subject comes from the Australian experience on the
prevention of Repetitive Strain Injuries (RSI). The Australian Health and Safety Cormmission
(Victorian Occ. HSH, 1988) establishes, first and foremost, that working periods with repetitive
movements exceeding 60 minutes, without recovery periods, cannot be considered acceptable. Within
this framework, general criteria are supplied, whereby the ratio between working time (with repetitive
movements), and recovery time must be of at least 5:1. Another indication comes from the ACGIH
statement for the year 2000 regarding WMSDs (ACGIH, 2000). In this statement, among others, it is
suggested that work standards should permit workers to pause or stretch as necessary but at least once
per hour.
A critical use of these guidelines (which the Authors feel they can agree with fully given the current
knowledge, and the indications in the literature) offers a key for the interpretation of the descriptive data
collected on sequence, duration and frequency of the recovery periods referring to cycles with previous
dynamic actions.
Evaluation of recovery periods in tasks including dynamic actions
In the case of repetitive tasks, those tasks where the technical actions are represented by movements
(and not by static positions) are obviously more frequent. Using the indications supplied by the
Australian Health and Safety Commission (Victorian Occ. HSH, 1988 and by ACGIH) as a starting
point - i.e., in case of repetitive tasks it is advisable to have a recovery period every 60 minutes, with a
ratio of 5(work): 1 (recovery) - the optimal distribution ratio of repetitive tasks and recovery seems to
be 50 minutes' work and 10 minutes' recovery (Figure 10.1).
Figure 10.1 - "Minimum" optimal distribution ratio of repetitive work and recovery
On the basis of this optimal distribution, it is possible to design criteria to evaluate the presence of
risk in a concrete situation: the risk may be due to the lack, or inadequacy, of the distribution of recovery
periods.
Upstream of this assessment, there must obviously be a correct analysis of the task/job, as previously
indicated.
A first analytical model is based on the distinction between repetitive work periods expended in
conditions with adequate recovery, and in conditions with potential overtiredness (the latter if no
adequate recovery period is available).
In practice, within every task, and then within every complete shift, a study must be made of how
much time has been expended in conditions of potential overload/overtiredness; this check is carried out
following the criterion that a recovery period of at least 10 minutes is necessary almost after 50 minutes
of repetitive work. The risk factor denoted as "lack of recovery periods" can then be added to the other
risk factors (frequency, force, posture, additional factors). This analysis can be carried out best by
subdividing the sequence of tasks and pauses by the hours making up the complete working shift: for
every hour, the time spent in the two conditions must be described (good recovery, overload). Starting
from the data obtained in this fashion, it will be possible to express the total time spent in the two
conditions, for every single task and for the whole shift: the optimal situation is represented by the
absence of time spent in conditions of potential overload.
ANALYSIS A N D EVALUATION OF RECOVERY PERIODS 89
E x a m p l e 10.1
Take a working situation where a single repetitive task is carried out (task A), and where the pauses are
distributed as follows"
The scheme described in Table 10.1 should be adopted:
Table 10.1 - Counting time respectively in good recovery or in potential overload (ex. 10.1)
Hour Task Minutes spent after Minutes spent

recovery in potential overload
1 A 50 10
2 A - 50
3 A 50 10
4 A - 60
5 LUNCH - -
6 A 50 10
7 A - 50
8 A 50 10
9 A - 60
Total 200 260
Out of 460 minutes of work with repetitive tasks, the overall time spent in conditions of recovery is 200 minutes, while 260
minutes are spent in conditions of potential overload. During these 260 minutes the factor "lack of recovery periods" is added
to, and interacts with, the other risk factors.
In the example offered, it is obvious that the criterion for the assessment of periods of recovery and
potential overload is that linked to the maximum continued period that can be spent in carring out
repetitive tasks in conditions defined as "acceptable" (50 minutes). All extra minutes, continuous with
respect to that period, which are spent without significant recovery periods, are considered as periods
of potential overload.
When recovery periods are adequate (ratio 5:1), and the working periods are shorter than 50 minutes,
no time in conditions of potential overload will be counted.
This analytical procedure can be adapted to the growing knowledge on the optimal ratio between
tasks implying repetitive movements and recovery periods. It may seem excessively detailed, and
90 RISK ASSESSMENT AND M A N A G E M E N T OF R E P E T I T I V E M O V E M E N T S AND E X E R T I O N S OF U P P E R LIMBS
therefore difficult to implement. To overcome this problem, a second analytical procedure has been
prepared, based on the same criteria, but easier to implement, although it simplifies more, and is
therefore less precise. It requires the observation, one by one, of the single hours that make up a working
shift: for each hour, a check must be made if there are repetitive tasks and if there are adequate recovery
periods. For the hour preceding the lunch break (if it is present), and for the hour before the end of the
shift, the recovery period is considered to be these two events.
On the basis of the presence or absence of adequate recovery periods within every hour of repetitive
work analyzed, each hour is then considered as being "risk-free", or "at risk" (lack of recovery periods).
The overall risk is determined by the overall number of hours at risk (generally, from 0 to 6).
Moreover, if within every hour of repetitive work the ratio between time worked/recovery periods is 5:1
to 6:l,the hour is considered as being risk-free (risk 0). If the ratio is between 7:1 and 11:1, the risk
assessed is 0.5. If the work/recovery ratio exceeds 11" 1, the risk factor is 1, because the ratio is judged
as being unsatisfactory.
Example 10.2
The same working situation as example 10.1"
1st HOUR = 60 min. WORK = RISK 1

(no recovery)
2 nd HOUR = 50 min. WORK 10 min. recovery = RISK 0
3 rd HOUR = 60 min. WORK = RISK 1
(no recovery)
4 th HOUR = 60 min. WORK = RISK 0
5th HOUR = 60 min RECOVERY
(no recovery)
10 min. recovery
8th HOUR = 60min. WORK =RISK 1
(no recovery)
9 th HOUR = 60 min. WORK + RECOVERY: end of shift = RISK 0
In summary, the risk due to a lack of recovery periods will scored 4 in this case. This value expresses
in how many hours the recovery is insufficient during the shift.
Over an 8-hour shift, interrupted by a lunch break, but with no other pauses at all, the maximum score
of 6 will be counted: in fact, the hour of work which is followed by the lunch break and the last hour of
ANALYSIS A N D EVALUATION OF RECOVERY PERIODS 91
w o r k in the shift, can be c o n s i d e r e d as "not at risk", b e c a u s e they are f o l l o w e d by a sufficient r e c o v e r y

period.
Example 10.3
In case the pause is at the beginning of the 3rd hour, or within one hour, then it must be considered as a
RECOVERY within the 3 rd hour, or the hour which contains it.
1o H O U R = 60 min. W O R K (no rec.) = RISK 1

2~ H = 60 min. WORK. = RISK 1
3~ = 50 min. WORK. 10 min. RECOVERY = RISK 0
4OH = 60min. WORK
5~ = 60 min. RECOVERY = RISK 0
6~ = 60min. WORK = RISK 1
7~ H = 60 min. WORK = RISK 1
8~ H = 50 min. WORK 10 RECOVERY = RISK 0
9~ H = 60 min. WORK+ RECOVERY at the end of shift = RISK 0
RISK 4
Example 10.4
A n a l y s i s o f r e c o v e r y periods within a cycle.
Take a 6 0 - s e c o n d cycle, during which, for 50 seconds, technical actions i m p l y i n g repetitive
m o v e m e n t s o f the u p p e r limbs are carried out (25 actions/minute), and for 10 c o n s e c u t i v e seconds the
u p p e r limbs are at rest (waiting for the m a c h i n e to do its processing). T h e task lasts, overall 2 hours (120
cycles).
92 RISK ASSESSMENT A N D M A N A G E M E N T OF R E P E T I T I V E M O V E M E N T S AND E X E R T I O N S OF UPPER LIMBS
WORK 5
In this case, the ratio within the cycle is the following:
RECOVERY 1
Although there are no other macro-pauses in the 2 hours during which the task is performed, the
situation seems to be adequate (presence of frequent micro-pauses of more than 10 consecutive seconds,
with a ratio of 5:1 between work time and rest time).
Example 10.5
Analysis of recovery periods within a cycle.
Take a 180-second cycle (25 actions/minute), during which for 20 consecutive seconds the upper-limbs
are at rest (waiting for the machine to do its processing).
In this case, the work/recovery ratio within the cycle is not sufficient: in fact, the ratio is 8:1.
It will be necessary to check whether the presence of RECOVERY PERIODS during the whole shift
is sufficient.
The repetitive task is carried out for 2 consecutive hours within a shift which includes also 2- 5
minute pauses, distributed as follows:
For every 55 minutes of work, 5 minutes of recovery are foreseen, with a ratio of 11:1, which is still
not sufficient.
Other recovery periods which accumulate over 55 minutes' work within the cycle must be
considered, as they total 6 minutes.
Within every hour, there are 5 minutes' pause, plus 6 minutes accumulated with all the micro-pauses
within the cycle. Therefore, for every hour there are 49 minutes of actual WORK, AND 11 minutes
RECOVERY. The 5:1 ratio is guaranteed.
Please remember that, for micro-pauses within the cycle to be considered as RECOVERY PERIODS
which can then be summed up for every hour of actual work, it is essential that they last at least 10
consecutive seconds, and appear at least every few minutes.
ANALYSIS AND E V A L U A T I O N OF RECOVERY PERIODS 93
Some practical .comments
The "rest factor", or "physiological factor", as defined in MTM studies, must be considered as actual
recovery periods only if they actually imply stopping the working activity for at least 5 consecutive minutes
within the task/s. If they do not reflect these total interruptions of activity they must not be counted: in fact,
they are included in the counting of the repetitive work times, and consequently reduce the action frequency.
If there are machine stoppage times which occur on a daily basis, or nearly, and which cause work
interruptions of at least 5 consecutive minutes, they must be counted as recovery periods.
When pauses are organized freely, which means that every worker can distribute his/her pauses freely
in terms of both number and duration (the overall duration being known), it is very important to
interview the workers and to carry out accurate observations, to determine the average behaviour of the
various groups of workers.
In some working situations a tendency emerges to accumulate pauses either right before or right after
the lunch break, or right before the end of the shift. These behaviours can probably be ascribed to
reasons other than the prevention of musculo-skeletal disorders and should be modified. Educational
and training programmes should be undertaken and so should a programmed organization of pause
distribution: accumulating pauses over the lunch break or the end of the shift makes recovery periods
assigned to prevent upper limb disorders totally useless.
The risk is increased when workers concentrate their pauses and also speed up their work, thus
shortening the cycle time to increase the duration of their rest period. For this reason, when there is a
net discrepancy between the theoretical cycle time and the cycle time actually observed, it is important
to analyze in detail the behaviour of the worker, so that (apart from action frequency at which he works),
a careful evaluation of the real duration and distribution of recovery times can be made. This detailed
study of the behaviour of the single workers determines their "customised", or "personalised" exposure
level (when it is different from the "average" behaviour) and it becomes essential when the individual
is a bearer of upper limb pathologies ascribable to bio-mechanical overload, whereby a risk/damage
ratio study becomes necessary for administrative or compensation purposes.
When pause distribution must be optimized, it is best to follow the criteria listed hereunder:
- it is best to separate the pauses as much as possible, so that there can be one after every 50 minutes
of repetitive work: their duration should not be less than 7 to 10 minutes;
- avoid the introduction of pauses during the hour before the lunch break and during the hour preceding
the end of the shift;
- avoid the uncontrolled accumulation of pauses during the hours which are close to the lunch break
and to the end of the shift;
- if tasks consisting mainly of visual control are present, they can be used as "recovery periods" for
"rotating" workers normally doing highly repetitive tasks;
- when the action frequency is not high ( = 30 actions/minute), and when cycle time is not too short
(less than l O seconds), the possibility exists to increase recovery times by shortening the cycle time
(but never less than 10 seconds), and consequently proportionally increasing action frequency (never
exceeding 50-60 actions/minute).
An evaluation of recovery periods referring to maintenance actions (or static actions)
Studies on muscle physiology referring to protracted static (isometric) contractions date back to the
1950s. These studies typically analyzed "endurance" (by which we meanthe maximum time during
which it is possible to maintain a certain static contraction according to the degree of muscular force
exerted). The recovery periods which become necessary have been analyzed in relationship to
endurance, after each static contraction, and at full rest of the muscle involved. These studies are now
consolidated in the literature, and are summarised in Table 10.2 (Rodgers, 1987, Rohmert, 1973). Table
10.2 shows, for different levels of contraction force (% with respect to MCV), and for different
durations of contraction (in seconds) the minimum necessary times for muscle recovery, expressed in
seconds, and percentage-wise withrespect to contraction times.
The use of this table is self-explanatory: for each holding condition (static condition), according to
the degree of force exerted, there must immediately follow an adequate recovery period. If this period
either does not exist, or if it is inadequate, then a risk situation emerges, which is all the more serious
as the difference between the real situation and the optimal situation increase. The importance of the
recovery period coming immediately after the substained exertion period for this kind of muscle
contraction cannot be underlined enough: in fact, it is not possible to organize the recovery periods by
accumulating them, as for movement actions.
Last, but not least, the prevention implication of the Table are obvious. It suggests the exact
subdivision between isometric contraction times and recovery periods, which should be alternated in
strict succession.
As a corollary to the table itself, and again for the purpose of prevention, it may be stated that the
force required during isometric contractions (albeit occasional), protracted for longer than 20 seconds
(maintenance), must not exceed 50% of MCV.
Table 10.2 - Calculation of recovery periods (in seconds and in percentage of contraction time)for operations
requiring isometric contractions (times equal to or greater than 20 seconds) by times and level of force required
Force (Borg's scale) Time maintenance Period recovery
20% MCV 20 2 10%

(Up to 2) 30 3 10%
45 7 15%
120 60 50%
180 180 100%
240 480 200%
300 1200 400%
450 2700 600%
30% MCV 20 10 50%

(About 3) 40 40 100%
60 120 200%
90 360 400%
120 720 600%
150 1200 800%
40% MCV 20 20 100%

(About 4) 30 60 200%
50 200 400%
70 420 600%
50% MCV 20 40 50%

(About 5) 30 120 400%
40 240 600%
90 720 800%
11. PROPOSED CONCISE INDEX FOR THE ASSESSMENT OF EXPOSURE
TO REPETITIVE MOVEMENTS OF THE UPPER LIMBS (OCRA INDEX)
Risk assessment indexes in the literature
A review of the most recent work in specialised literature focusing on the description, quantification and
assessment of the various occupational risk factors which may, either alone, but more frequently in a
combined fashion, contribute towards the onset of musculoskeletal pathologies, has not produced any
appropriate and univocally recognised analytical methods that can be used in the field for the concise
assessment of relative risk exposure (i.e., taking into account the main risk factors) (Hagberg et al.,
1995). There are partial exceptions to this basic consideration. For example, Drury (1987) proposes a
method for calculating the total daily number of harmful movements for the wrist, taking into account
such factors as force, repetitiveness and posture; Silverstein (1985) supplies criteria for framing
exposure with relationship to repetitiveness and force; Tanaka and McGlothin (1993) propose an
integrated model (regrettably, only theoretical) for the assessment of repetitiveness, force and posture
in determining the risk of carpal tunnel syndrome. Lastly, Moore and Garg's more recent work (1995)
proposes an exposure index which derived from the examination of six separate variables (force,
frequency, posture, recovery periods within the cycle, movement velocity and duration).However,
despite their growing complexity and validity (also considering the date of publication), all of these
approaches are either biased or not sufficiently exhaustive in defining the variables - especially those
referring to the analysis of organized work, which are still lacking in light of the definitions and
analytical methods presented in the previous chapters. Importantly, the latter proposals follow the
criteria adopted by NIOSH in its proposals for the concise assessment of manual handling tasks
(NIOSH LIFTING EQUATION). These consist of a concise exposure index calculating the effect of the
main risk factors, starting from the most critical variable.
Countless analytical methods employ more or less simplified check lists: these are easy to fill out,
but unfortunately feature the same individual tasks performed throughout the entire shift, and restrict
themselves to a mere handful of risk-related epiphenomena. Therefore, they are too poorly structured
for a detailed analysis of the various risk factors which is also prevention-oriented.
In some cases, the use of a check-list involves the production of elaborate scores (e.g., number of
negative responses; number of responses marked by asterisks indicating the presence of potential risk;
etc.) that tend to guide users according to the presence or absence of significant exposure (Keyserling
et al., 1993). The Authors, together with various colleagues in the literature, feel that only the most
reputable of these check-lists should be employed, and then only for screening analyses where an initial
and rough estimate of the presence/absence of potential exposure risk is required. When more detailed
analyses are required, especially those necessary to organize preventive actions, it is important to use
procedures that can effectively quantify the various risk factors, and their contribution to overall
exposure.
The procedure described here serves for the calculation of a concise index (OCRA* risk index) of
exposure to repetitive upper limb movement related risk which will comply with the above-described
requirements.
T h e r e f e r e n c e f r a m e w o r k for the c a l c u l a t i o n m o d e l
The proposed concise index is based on three premises:
1) The need for an integrated assessment of the contribution of the main occupational risk factors (i.e.,
frequency/repetitiveness, force, posture, lack of recovery periods, additional factors) starting from
the simplified quantification methods presented in the previous chapters;
2) The need to develop a concise index "calculation model", similar to that proposed by Waters et al.
(1993), for the assessment of manual load lifting tasks. The key points of that method are the
following:
- an exposure index deriving from the comparison between the "weight actually lifted" and the
"reference weight" recommended, according to the specific characteristics of the workplace and
its organization;
- the concurrent contribution of the various risk factors in determining the value of the reference
variable;
- selection of a "characteristic variable" as a reference point in so-called optimal conditions, subject
to appropriate corrections (multiplying factors) according to the characteristics of the other risk
factors considered;
- a reference score (lifting index = 1), indicating largely acceptable conditions for the majority of
the healthy adult working population. Any increase in this value would suggest increasingly
dangerous exposure levels: accordingly, different preventive actions can be identified;
- a strong propensity to preventive action, based on the identification and correction of risk factors
which are most destabilising for the "characteristic variable".
3) The characteristic variable for repetitive upper limb movements should be identified as the
f r e q u e n c y o f t e c h n i c a l a c t i o n s (in no. o f a c t i o n s p e r minute). In the field experiences to date, until
now this variable has proven the easiest to learn and use, even for the technicians and engineers who
design productions processes and related operating methods. For them, in particular, the reference to
"technical actions" is extremely clear, both in terms of exposure assessment and of any successive
correction in work design.
On the basis of the above points, the Authors suggest adopting the OCRA exposure index that is the
result of the ratio between the number of technical actions (performed during repetitive movement
tasks) actually carried out during the work shift, and the number of technical actions which is
specifically recommended.
Overall n ~. of technical actions carried out in the shift

In practice, O C R A -
Overall n ~. of technical actions recommended in the shift
The overall number of technical actions carried out within the shift is a known datum, which is
calculated by organizational analysis (please see Chapter 6).
* OCRA = OCcupational RepetitiveActions.

P R O P O S E D C O N C I S E I N D E X FOR T H E A S S E S S M E N T OF E X P O S U R E . . . 97
The following general formula calculates the overall number of technical actions recommended
within a shift:
n
N ~ Recomm. technical actions = ~ , [CFx (Ffix Fpix Fcl)x Di] x Frx Fd
x=l
where
1, n = task/s performed during shift featuring repetitive movements of the upper limbs;
CF = frequency constant of technical actions per minute recommended under optimal
conditions.
Ff; Fp; Fc - multiplier factors with scores ranging from 0 to 1, selected according to the behaviour of
the "force" (Ff), "posture" (Fp) and "additional elements" (Fc) risk factors in each of the
(n) tasks;
D = duration in minutes of each repetitive task.
Fr = multiplier factor, with scores ranging between 0 and 1, selected according to the
behaviour of the "lack of recovery period" risk factor during the entire shift.
Fd = multiplier factor, with scores ranging between 0.5 and 2, selected according to the daily
duration of tasks with repetitive upper limb movements.
In practice, to determine the recommended overall number of actions within a shift, proceed as
follows"
a) for each repetitive task, start from the maximum recommended tecnical action frequency per minute
(CF = 30 actions/minute). This becomes the reference constant for any repetitive task, given all other
risk factors as optimal or not significant (force, posture, additional factors, lack of recovery periods).
The use of this constant will be discussed in greater detail further on.
b) For each task, the frequency constant must be corrected for the presence and degree of the following
risk factors" force, posture and additional. Tables are supplied for this, with the different scores
assigned to the multiplier factor according to the degree of the risk factors' presence, e.g.,
CF • (Ffi • Fpi • Fci) = oL i =ith task

c F x (Ffj x Fpj x Fcj) = j = jth task
c) multiply the weighted frequency thus obtained for each task by the number of minutes of actual
performance of each task (DI and DJ);
e.g." et • ~3XDj
d) sum up the values obtained for the different tasks (where the repetitive task considered is unique, this
is not necessary);
e.g." (ix X Di ) + ([3 X Dj) = rr
e) the resulting value (Tr) is multiplied by the multiplier factor, which considers both presence and
sequence, in the whole shift, of recovery periods. Here too, a table is provided for the conversion of
the data from the analysis into the multiplier factor values
e.g." -rr X Fr - Ar
f) apply the (Fd) multiplier factor to the A r value thus obtained; it considers the total time (in minutes)
spent in doing upper limb repetitive tasks during the shift;
e.g.: ArX Fd = Arp
g) the value thus obtained Arp represents the total recommended number of actions in the working shift:
It is determined according to the presence of the various significant risk factors in the context under
examination. The value of Arp is the denominator of the fraction which expresses the OCRA concise
exposure index. The numerator (Ae) will be the total number of actions actually carried out within
the repetitive tasks examined;
Ae
OCRA -
ArP
When the exposure index is lower than, or equal to 1, occupational exposure must be taken as being
non-significant, or acceptable. Exposure is significant for values greater than 1" the higher the index, the
greater the exposure.
Since the values of all the variables included in the equation for calculating the index are still
hypotheses awaiting confirmation, for practical purposes it is advisable to adopt a conservative
classification system of the results of the exposure index, based on the "traffic light" approach (green,
yellow, red).
Given the current level of knowledge, the following can be stated:
- index values lower or equal to 1 mean full acceptability of the condition examined (green area);
- index values between 1 and 2 (yellow/green area) mean that exposure is still not relevant, or not
enough to foresee significant excesses in the occurrence of WMSDs in the exposed groups versus the
reference groups. In these cases; the exposure level can, in terms of consequences, be considered as
similar to that of the green area.
- Index values between 2.1 and 3.9 (yellow/red area) mean that exposure is not severe, but that there
could be higher disease levels in the exposed groups with respect to a reference group of non-
exposed. In these cases, especially for the higher score ranges, it is advisable to introduce health
surveillance, health education and training of the exposed workers, and where possible, proceed to
an improvement of working conditions.
- Index values equal to, or greater than 4.0 (red area) mean significant exposure levels, all the greater
with the higher score ranges. Values above 4 definitely represent a collective overt risk of WMSDs
for operators. Working conditions must be improved in these cases (the analysis data will be useful
guidance to prioritize this), and close monitoring of all effects must be set up.
C r i t e r i a a n d p r o c e d u r e s for d e t e r m i n i n g t h e v a r i a b l e s i n v o l v e d c a l c u l a t i n g t h e e x p o s u r e i n d e x
A brief illustration and discussion follow reviewing the criteria and procedures involved in the
determination of the concise exposure index calculation variables.
PROPOSED CONCISE INDEX FOR T H E ASSESSMENT OF E X P O S U R E . . . 99
L The action frequency constant (CF)
Technical action frequency is the variable which best characterizes exposure whenever upper limb repetitive
movements are analysed. Once the technical actions involving the upper limbs have been adequately
defined, the main issue is to establish the reference action frequency for the whole working shift.
The literature, albeit not explicitly, supplies suggestions of "limit" or threshold action frequency
values, for similar actions, and these range from 10 to 25 actions per minute. However, these values
mainly refer to similar occupational movements (flexion-extension, radio-ulnar deviations). Obviously,
when speaking of upper limb technical actions in general, it is probable that the joint movements will
be more varied than this.
It is, however, just as obvious, that a high technical action frequency (e.g., over 50/60 per minute)
will imply excessively short times for muscle contraction and relaxation: a sustainable situation for
occasional jobs, or tasks of very brief duration, but certainly not for lengthy periods of time (exceeding
1 hour).
On the basis of the above and practical considerations of the applicability of these proposals in the
work place, the action frequency constant (CF) is temporarily fixed at 30 actions per minute. This value
will obviously be subject to changes in the future, when more experimental data will be available on the
index and the effects of its application.
The wide borderline area (yellow light) in the interpretation of index results is also due to the
uncertainties in the choice of the constant's values, the constant being the access point for the
calculation of the index itself.
II. Force factor (Ff)
The higher the force required to execute a series of technical actions, the lower their frequency will have
to be. Data on the relationship between action frequency and average force is extrapolated on the basis
of a 1993 CEN draft (CEN, 1993), which suggests how to identify multiplier factors which must then
be applied to the action frequency constant, according to the entity of the average force (or effort
perceived) in the cycle, and therefore also in the task (see Table 11.1).
When choosing the multiplier factor, it is necessary to refer to the average force value, weighted by
cycle duration. If technical actions requiring the exertion of force exceeding a Borg score of 5 were
found, lasting at least 10% of cycle time, the multiplier factor to be used is 0.01.
Table 11.1 - Elements for the determination of the multiplier factor for force (Ff)
Force Average
factor perceived effort
(Borg CR- 10
scale) >0.5 1 1.5 2 2.5 3 3.5 4 4.5 5
Average force
(% MVC) >5 10 15 20 25 30 35 40 45 50
Multiplier
factor 1 0 . 8 5 0 . 7 5 0 . 6 5 0 . 5 5 0 . 4 5 0.35 0.2 0.1 0.01
I OO RISK ASSESSMENT AND M A N A G E M E N T OF R E P E T I T I V E M O V E M E N T S A N D E X E R T I O N S OF U P P E R LIMBS
III. Postural factor (Fp)
The literature supplies frequency limits for specific actions or movements which are equal to each other:
the 1993 CEN proposal is valid (20 actions/minute with power grip, if carried out for 30 minute
periods), and so is Kilbom's (10 actions per minute for equal movements of the wrist and elbow)
(Kilbom, 1994). In the models which have already been suggested here for the description of postures
and movements, the presence of stereotypy (working gestures of the same type) for over 50% of cycle
time (and therefore for over 50% of task time, too) is, per se, considered as a risk. In the same models,
the presence of movements and/or postures exceeding 50% of joint range and occupying at least 1/3 of
cycle time is also considered as being a risk condition.
Combinations exceeding these "minimal" scenarios of postural risk present a potentially much
greater risk. All of these elements together lead to the design of a useful scheme to identify the values
of the posture multiplier factor (Fp), in relation to the results of the description and assessment
classification. In this scheme the postural involvement score of 4 (stereotypy of gestures maintained for
over 50% of cycle time) corresponds to a factor of 0.70; this factor, by itself, reduces by approximately
30% the "reference" number of technical actions in a given time unit. Where postural involvement is
less, the multiplier factor scores are higher.
Table 11.2 gives the data for calculating the corresponding multiplier f a c t o r - starting from the
postural involvement descriptive score -. This table must be used for all three segments of the upper
limb (elbow, wrist and hand). In order to calculate the index, the most penalising score must be taken
from among those referred to each of the previously mentioned segments. The shoulder involvement
index will be dealt with separately (and used for preventive re-design purposes), since at the moment it
would be necessary to define a different general frequency constant than those found for the other
segments (as a starting point).
There are many uncertainties concerning the shoulder; but when the shoulder joint is mainly involved
in movements in risk areas (over 50% of joint range) it would be useful to have a specific index. In fact,
repetitive shoulder movements, especially in awkward postures, may lead to the onset of humero-
scapular periarthritis. Conversely, simply keeping the upper limbs uplifted will mainly lead to the
involvement of the cervical muscles and the trapezium. To obtain the specific shoulder exposure index,
the value found for the shoulder can be used for the postural risk, and the final index, obtained as for
the other joints, is multiplied by 2. This is equivalent to identifying an ideal action frequency for the
shoulder, equal to 15 actions/minute (all other risk and postural factors being absent).
This postulate still needs to be proven and perfected, but it allows the definition of an exposure index
for this segment, when it is involved in actions with wide and repetitive movements.
Table 11.2- Elements for the determination of the postural multiplier facwr (Fp)
Postural involvement score 0-3 4-7 8-11 12-15 16

Multiplier factor 1 0.70 0.60 0.50 0.3
IV. "Additional elements" factor (Fc)
No assessment grids and multiplier factors can be derived from the literature concerning the presence
and degree of additional elements. The Authors therefore postulate a range of values to be assigned to
PROPOSED CONCISE INDEX FOR T H E ASSESSMENT OF E X P O S U R E . . . IOI
the relevant multiplier factors, according to the presence and severity of the various additional elements,
as classified in the analytical description phase. The starting point is the criterion that the additional
factor should not contribute too extensively to decreasing the number of possible technical actions
within a given time unit (maximum reduction 20%).
Table 11.3 shows the necessary elements for attributing the "multiplier factor for additional elements"
(Fc), based on the descriptive classification proposed elsewhere in this book.
Table 11.3- Elements for the determination of the multiplierfactor for additional factors (Fc)
Postural involvement score 0 4 8 12

Multiplier factor 1 0.95 0.90 0.80
V. "Recovery periods" factor (Fr)
All other multiplier factors must be determined by considering each of the possible repetitive tasks that
make up the shift; but the recovery periods factor must be determined by considering the whole of the
working shift, and, within it, the actual sequence of repetitive task periods, of recovery periods, and also
any periods of non-repetitive work that cannot be considered as recovery periods.
In the general concise index model presented here, the first thing is to determine the absolute number
of recommended actions, both overall and for each single task, starting from the frequency constant (for
the duration of the task), and considering the Ff, Fp, Fc factors. After this step, the absolute number of
"recommended "actions is further weighted according to the presence, distribution and adequacy of the
recovery periods within the shift. Fr factor values are based on a criterion deriving from the 1993 CEN
proposal, already mentioned elsewhere in this chapter.
This proposal states that for similar actions (e.g., gripping tightly with the hand), all other factors
being insignificant (posture, force, additional), the maximum acceptable frequency for about 30
continuous minutes of work is equal to 20 actions per minute. If these actions are protracted throughout
a normal working shift, with the usual pauses (one in the morning and one in the afternoon), then the
acceptable frequency of the same actions is 5 actions per minute.
Basically, this proposal brings down the allowed action frequency by 75%, ranging from a scenario
of one hour to one applicable to the whole shift. The reason is obvious: to compensate for the long
duration and inadequate recovery periods, the action frequency is lowered to ensure adequate recovery
to take place within the cycle itself.
When repetitive work takes place throughout the shift without sufficient recovery periods, the
multiplier factor for allowed actions is 0.25. This criterion was the guideline that led to the preparation
of a conversion grid (Table 11.4.), from the results of the simplified analysis on the presence/distribution
of recovery periods, to the corresponding multiplier factors.
For every hour without an adequate recovery period, there is a corresponding multiplier factor: one
single hour in the shift without adequate recovery F r - 0.90; two hours in the shift without recovery Fr
= 0.80, and so forth.
IO2 RISK ASSESSMENT A N D M A N A G E M E N T OF REPETITIVE MOVEMENTS AND EXERTIONS OF UPPER LIMBS
Table 11.4 - Elements for the determination of the recovery period multiplier factor (Fr)
N ~ of hours without adequate recovery 0 1 2 3 4 5 6 7 8

Multiplier factor 1 0.90 0.80 0.70 0.60 0.45 0.25 0.10 0
VI. Duration factor (Fd)
Within a working shift, the overall duration of tasks with repetitive and/or forced upper limb movements
is important to determine overall exposure. The index calculation model is based on scenarios where
repetitive manual tasks continue for a good part (4 hours or more) of the shift. In some contexts,
however, there may be deep differences with respect to the more "typical" scenario (e.g., regularly
working over-time, part-time work, repetitive manual tasks for only part of a shift), and that is why the
multiplier factor was structured to consider these changes with respect to usual exposure conditions.
Table 11.5 supplies the necessary parameters for dealing with the duration factor (the time indicated in
minutes is the total sum of time expended during the shift in repetitive upper limb tasks.
Table 11.5- Elements for the determination of the duration multiplier facwr (Fd)
Minutes devoted to repetitive tasks during shift < 120 120-239 240-480 > 480
Multiplier factor 2 1.5 1 0.5
The choice of the Fd factor values was made on the basis of similar indications found in the literature
(Moore and Garg, 1995; CEN, 1998; ANSI, Z-265, 1995).
VII. Index calculation checklist
A checklist has been prepared on the basis of all the elements presented and explained up to this point:
it collects in an orderly fashion all the data from the previous descriptive analysis, and enables an easy
calculation of the concise exposure index, even in the presence of many repetitive tasks (Table 11.7).
Each checklist considers both limbs (right and left) if they are both involved. The analysis is
structured as follows. There is a first part summarising the main elements which characterize the
repetitive tasks analysed (Table 11.7), and a second part focusing on the index calculation (Table 11.6).
Table 11.7 identifies and quantifies the following in particular:
- department or line, and type of work carried out by the group of exposed operators;
- characteristics of each repetitive task (up to a maximum of 4 repetitive tasks per shift), such as
average duration of the cycle (in seconds), average action frequency (in number of actions per
minute), total duration of each task (in minutes);
- the total number of actions carried out within each repetitive task and within the whole of the working
shift;
- the number of pauses and the non-repetitive tasks which can, or cannot, be considered as recovery
periods.
PROPOSED CONCISE INDEX FOR THE ASSESSMENT OF E X P O S U R E . . . 103
Table 11.6
CALCULATION OF OCRA EXPOSURE INDEX
RIGHT ARM LEFT ARM

A B C D A B C D Task/s
9 Action freauencv constant (no. of action,~/min.) 30 30 30 30 30 30 30 30 C.F.
9 Force faqtor (perceived effort)
BORG 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 i n n n n n m Task/s
FACTOR 1 0.85 0.75 0.65 0.55 0.45 0.35 0.2 0.1 0.01 Ff
x
m
9 Postural factor C D A B C D Task/s
SHOULDER (*) select lowest factor

VALUE 0-3 4-7 8-11 12-15 ELBOW between elbow, wrist
and hand
FACTOR 1 0.70 0.60 0.50 o.3s WRIST
HAND Fp
9 Additional factors
VALUE 0 4 8 12 C D A B C Tasldsi
FACTOR 1 0.95 0.90 o.eo Fc

x
9 Duration of repetitive task A B C D A B C D TaskJs
RIGHT LEFT
~r
no. recommended actions for reoetitiv(~
task, and in total (partial result, without
Recovery factor) a p y 6 a p 6 (a+p+y+O) (a+p+y+~))
9 factor referring to the lack of recovery periods (no. of hours without adequate recovery)
9
m'=''===''l=-
factor referring to overall duration of repetitive tasks
RIGHT LEFT
MINUTES < 120 120 - 239 240 -480 > 480 Fd -- Arp = ~ x Fr x Fd Arp = ~ x Fr x Fd
FACTOR 2 1.5 I 0.5 i ~ l I
RIGHT LEFT RIGHT LEFT

Total no. of actions observed in repetitive tasks Ae
l e E . ----"
No. recommended actions Alp
Table 11.6 is structured for the calculation of the index:
- for each of the tasks under examination, one begins with the frequency constant (CF), which is equal
to 30 actions per minute;
- this constant is then multiplied by the perceived effort factor (Ff), which is calculated for each task
with the aid of the conversion grid supplied; the postural factor (Fp) is then considered and a further
multiplication takes place. Here, too, the choice of the factor is guided by a conversion grid including
descriptive and multiplier factors. The relevant spaces are left to be filled in with the values referring
to the four joint segments (hand, wrist, elbow, shoulder). It is necessary to proceed by selecting the
worst multiplier factor among the elbow, wrist and hand ones (the index is specifically structured for
repetitive movements of these segments). For the shoulder, please see the previous section.
- The choice is then made, and the multiplication by the factor concerned with the additional elements
(Fc) is carried out.
- The result of these three multiplications (which is not indicated in the checklist) represents the
frequency constant per minute, weighted by the force, postural, and additional factors. The same
result, multiplied by the duration, in minutes, of each of the tasks considered, leads to the calculation
of the number of recommended actions per task: then, by summing everything, it gives the total of
recommended actions per shift (-rr).
- It now becomes necessary to weight the total number of recommended actions (-tr), as they appear in
the partial result, for the presence and distribution of recovery periods (Fr): this will act as multiplier
of the result obtained at the previous point ('rr).
- The Fd factor is now used: it considers the overall duration of repetitive tasks within the shift;
- In this fashion the required value is obtained: it is the total number of recommended actions within
the shift (Arp).
This factor represents the denominator of a fraction whose numerator is the total number of actions
actually carried out during the working shift. This number is found in the first part of the checklist (Ae).
This fraction, or better, this ratio represents the OCRA exposure index to repetitive movements of the
upper extremities.
A practical example of how to calculate the OCRA index
In the previous chapters devoted to action frequency and to the study of force and posture, an example
of a repetitive job has already been analysed: it is characterized by two tasks, A) the welding of a rod,
and B) cutting off a terminal hole. By collecting all the data on the single risk factors that have already
been analysed, it is now possible to calculate the OCRA index.
Table 11.7 calculates the total number of technical actions for every single task in the shift, and for
both task and shift as a whole (separately for the right and left upper limbs). The next Table 11.8
contains all the values measured for the various risk factors, and for each of the values the
corresponding multiplier factor can be found.
There are 4 boxes for the fight upper limb and 4 for the left in the analysis form (A - B - C - D),
and they have a corresponding column each.
Each letter refers to a different repetitive task carried out during the shift. If, during the shift, there is
only one repetitive task, then column A) alone will be filled in (one for the right and one for the left).
If, on the contrary, there are many repetitive tasks (as in the example), one task must be attributed to
each letter (and to each corresponding column).
PROPOSED CONCISE INDEX FOR THE ASSESSMENT OF E X P O S U R E . . . I O5
Table 11.7
SUMMARISED DATA F O R THE CALCULATION OF THE T O T A L N U M B E R OF

T E C H N I C A L ACTIONS CARRIED OUT WITHIN A SHIFT F O R R E P E T I T I V E TASKS
Line. .................. Work-place W E L D I N G A R O D (A) .......... Shi#.d ~ e H ~ ....

,, C U T T I N G A T E R M I N A L H O L E (B)
Characte.risation of repetitive tasks within a shift

I
RIGHT ARM LEFT ARM

I
TASKS TASKS
A B C D A BIc D
9 Duration of task within the 225.2 96.4 225.2 96~4
shift (mia)
9 Average duration of cycle (see) 6
9 Action frequency 53.3 63.7 40 40

(n.actions/min)
~ Total actions in task 12003 9008
9 total actions in shift 18144 ke 12864 Ae

(sum of A, B, C, D)
(total actions) (total actions)
Characterisation of non-repetitive tasks within the shift

I
TASKS
X Y Z
9 Total minutes of task/s that can
be considered as recovery period
9 Total minutes of non-repetitive 48 48 24

task/s that cannot be considered
as recovery period
NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
e o o ~ e ~ o ~ o ~ o ~ o o ~ ~ o e o ~ e o ~ e o o o e j o ~ o o ~ e e o o o e e ~ ~ e ~ o ~ e e ~ e ~ e e e ~ e o e e e ~ e e e ~ e ~ e e ~ e e e o o e e e ~ e ~ e ~ e ~ e ~ e e e e ~ e ~ e
o * o e e e o o o eoooooeq, ooo, o ~ e ~ o ~ e o * ~ ~ o ~ o ~ e o ~ e ~ e ~ e e ~ e ~ e ~ o ~ e e ~ o o ~ o o o e ~ e ~ o ~ e ~ e ~ o e o ~ ~
IO6 RISK ASSESSMENT AND M A N A G E M E N T OF REPETITIVE MOVEMENTS AND EXERTIONS OF UPPER LIMBS
Table 11.8
CALCULATON OF THE OCRA EXPOSURE INDEX

A) Welding of the rod B) Cuttlng of the terminal hole
RIGHT ARM LEFT ARM
A . c D A B C D Task/=
* Action frequency constant (no.acUons/min.) 30 30 30 30 30 30 30 30 C.F.

X
9 Force factor (perceived force)
BORG 0.6 1 1.5 2 2.5 3 3.6 4 4.5 s A B A B C D Tuk/s

FACTOR 1 0 . 8 5 0.75 0.65 0.55 0.45 0.35 0.2 0.1 0.01 0.90 0.90 0.80 0.90 Ff
A) 0.80 right 1.15 left (Borg)

B) 0.9 right 0.9 left(Borg)
9 Posturalfactor A B C A B C D Task/s
SHOULDER 16 8 12 8 Select the highest value
VALUE ELBOW lO 8 10 8 Between elbow, wrist,
FACTOR WRIST 8 1o 4 10 And hand to calculate
HAND 11 12 14 12 Postural factor
0.6 0.5 0.S o.s Fp
X
VALUE 0 4 8 12 A B A B C D Taslds
FACTOR 1 0_95 0.90 0.80 1 1 1 1 Fc
x
9 Duration of repetitive task (rain) A B C A B C D TaslVs
225 96 225 96
RIGHT LEFT
m,mm ,m,=mam,m
4941 3996
no recommended actions, both
total and per repetitive task
a p, y b a y 8 (a+13+y+8) (a+13+y+8)
(partial resultwithout recoveryfactor)
9 lack of recovery periods factor ours without adequate recovery) RIGHT LEFT
HOURS I o I 1 I 2 I a 1'1'1'1 Fr Arp = = x fr x fd Arp ,, = x fr x fd
//uui ialil n I 23, e

9 overall repetitive task duration factor
.o .12o 12,= ..o

HOURS / /
FACTOR 2 1.5 ~ 1' 1 0.5 ! 1 I
O C R A INDEX
Total no. actions observed in repetitivetasks Ae 18144 12864
I.E. = =-------- 6.1 5.4
no recommendedactions Alp 2964 2397.6
PROPOSED CONCISE INDEX FOR THE ASSESSMENT OF EXPOSURE... IO7
As for the average force value weighted by time found with Borg's Scale, the values are found in the
checklist. They have their corresponding multiplier factors, separately for fight and left, in boxes A) and
B). If the value found does not correspond exactly to the one indicated in the table, via a proportional
interpolation calculation it is possible to find the precise value of the multiplier factor.
For the postural risk factor, the checklist must be filled in with the scores found for the 4 indicated
joint segments" for each task it will be necessary to select the highest value, to which the lowest
multiplier factor value corresponds (excluding the shoulder, for which different risk estimation systems
are required).
Once the corresponding factor is found for the additional risk factors score, the boxes should be filled
in with the minutes of duration of each repetitive task (in the example, 225 minutes for task A and 96
minutes for task B).
It is now possible to calculate the recommended actions (valid up to this point), by multiplying the
initial value of 30 by all the multiplier factors shown up to now. The results are 3645 for task A and
1296 for task B for the fight arm. Adding the two values gives the number of recommended actions in
the shift for the right upper limb, but without having yet considered the "recovery period" and duration
factors. The same calculation must be repeated for the left upper limb.
To obtain the recommended number of actions in the shift, it is then necessary to multiply the partial
values obtained by the factor indicating the lack of recovery periods (here it is 0.6) and by the "duration"
factor (here it is 1): the number of recommended actions is 2964 for the right, and 2398 for the left.
The OCRA index is obtained by relating the total number of observed actions to that of the
recommended actions.
In the task analysed, the resulting values are both high: 6.1 for the fight and 5.4 for the left (red area).
Sometimes, turnover on many tasks does not finish with the end of the shift, but is completed in one
week, one month, or maybe one season. In such cases, as already mentioned in Chapter 5, it is necessary
to find the percentage of time the single operator spends carrying out the task in the period under
examination.
With reference to example 5.B in Chapter 5, the seasonal tasks were:
% Minutes~shift
Picking olives 20 86
Picking artichokes 20 86
Picking aubergines 20 86 Total
Filling jars 30 129 430
minutes
Tuna preparation 5 21.5
Preparation mixed vegetables 5 21.5
The seasonal percentages have already been transformed into the minutes per shift of a hypothetical
working day and it is now possible to estimate the OCRA exposure index, as if this were a normal shift
with many repetitive tasks.
When the tasks carried out in the span of time under consideration (month, season, etc.) are very
numerous (more than 6, 7, 8), it is best to limit the calculation of the exposure index to the 4 or 5 most
representative tasks.
IO8 RISK ASSESSMENT AND MANAGEMENT OF REPETITIVE MOVEMENTS AND EXERTIONS OF UPPER LIMBS
First validations of the O C R A Risk Index and predictive models
The OCRA exposure index presented here is a model for the aggregation of data obtained by descriptive
analysis of various occupational risk factors, as shown in the previous chapters.
The index was constructed on the basis of a series of indications found in the literature. It still needs
progressive validation and it may need to be modified, especially according to parallel studies on the
effects (musculoskeletal pathologies and disturbances) induced on groups of operators with different
degrees of exposure to different working conditions and different index levels. Recently (Colombini et
al., 1998) the Authors presented the initial application studies to this end, making it possible to:
- find high levels of association between the OCRA index and WMSDs prevalence in exposed
operators;
- identify sufficiently reliable predictive models for upper limb pathologies according to the OCRA
index;
- given the current state of the art, state the corresponding values for the different exposure groups and
action areas (green, yellow and red).
Over the years, these studies have been expanded upon by both the Authors themselves and other co-
workers (Occhipinti et al., 2000).
They have been, and will continue to be printed in the specialised journals.
It is not the aim of this work to offer a detailed and analytical review of all these studies, but the
Authors present the current main results.
Association between OCRA, W M S D S occurence and predictive models
The relationship between OCRA and WMSDs can be summarised in the following simple regression
linear equation:
Y=4.2X
n ~ WMSDs
Where: Y = 9 100 X = OCRA index
n ~. exposed individuals
This regression equation is calculated without the constant (e.g., if OCRA is 0, then there are no
WMSDs), and starting from the data examined until this moment, it has an R 2 of 0.89, and extremely
high statistical significance (p < 0.00001).
The term WMSDs / no. exposed individuals stands for the prevalence of single upper limb
occupational pathologies calculated on the number of exposed individuals. This datum is obviously
different from the alternative one which is used: the prevalence of individuals affected by WMSDs (one
or more).
If the regression equation shown previously is being used as a predictive model (in this way the
OCRA index becomes a forecast index of collective risk for a given exposed population to contract
WMSDs) the confidence limits (95%) within which the forecast may oscillate must be considered. On
the basis of the data available, the latter limits will in turn make the OCRA multiplier factor (4.2)
oscillate between 3.2 (minimum value) and 5.2 (maximum value). Therefore, the equation which
expresses the forecast model (95% confidence) can be expressed as follows:
PROPOSED CONCISE INDEX FOR T H E ASSESSMENT OF E X P O S U R E . . . 109
Prevalence (%) WMSDs = (4.2 + 1) OCRA
By adopting this type of model, once the OCRA index has been calculated, it is possible to estimate
the prevalence of WMSDs that can be expected over a general ten-year span for the group of exposed
individuals.
Table 11.9 shows examples of forecasts, with specific OCRA index values.
Table 11.9 - Prediction of WMSDs prevalence in a group of exposed individuals (lO-year basis), given specific
OCRA index values
Forecast of WMSDs (%)

OCRA value Min. Central Max
1 3.2 4.2 5.2

2 6.4 8.4 1.4
4 12.8 16.8 20.8
8 21.6 33.6 41.6
Currently available data, although with a little more approximation and possibly underestimation, has
also made it possible to obtain good associations between the OCRA index and new WMSDs cases (in
terms of incidence). In this case, the association is expressed by the following simple linear regression
equation (still without a constant):
Z = 0.336 X
where Z = yearly incidence (per 100 exposed individuals) of WMSDs
X = OCRA index
This equation has a n R 2 - 0.84 and has a high statistical significance, which confirms the positive
association between the two exposure and effect indices.
In this case, too, it is possible to calculate the confidence limit (95%) of the regression line, which
becomes:
INCIDENCE (%) WMSDs = 0.336 (+ 0.095). OCRA
Certainly this predictive model is less accurate than the previous one, but still a useful reference, as
shown in Table 11.10.
Despite their limitations, the availability of these models is of great importance for setting and
monitoring prevention targets which must, first and foremost, be aimed towards a continuous
improvement and the lowest exposure levels (and foreseeable consequent damage) possible.
O C R A Values, exposure areas and consequent actions
The studies and experiments carried out so far have basically proven the validity of the choices which
had initially been made to identify the different exposure areas (green, yellow and red lights) with key
I IO RISK ASSESSMENT A N D M A N A G E M E N T OF R E P E T I T I V E M O V E M E N T S A N D E X E R T I O N S OF U P P E R LIMBS
Table 11.10- Prediction of yearly incidence of new WMSDs cases in a group of exposed individuals, given the
OCRA resulting values
Incidence forecast (%)

OCRA value Min. Central Max
1 0.242 0.336 0.431

2 0.48 0.672 0.86
4 0.97 1.34 1.72
8 1.94 2.69 3.45
OCRA scores. They have definitely been useful for a better classification of results, especially in the
yellow area.
By considering the trend of WMSDs pathologies in reference to working populations which are not
exposed to specific occupational risks, with the aid of Table 11.11 it is possible to further confirm the
OCRA index classification criteria and to indicate the consequent preventive actions to be adopted.
Table 11.11 - OCRA index classification criteria with indications of consequent preventive actions
Area OCRA values Risk level Consequences
GREEN < 1 NO RISK No consequences
YELLOW/ 1.1-2 VERY LOW RISK No consequences

GREEN WMSDs forecast is
similar to that for the
reference group
YELLOW/ 2.1-3.9 LOW RISK - Advisable to set up

RED Forecast of slight increase health surveillance
(up to three-fold) - Advisable to set up
of WMSDs improvement actions
for exposure
conditions, especially
for higher scores
RED >
m
4 PRESENCE OF RISK - Re-design of tasks and
The higher the index, workplaces according
the higher the risk. to priorities
Health surveillance and - Health surveillance,
training for improvement training and
are required, and so is information
re-engineering for safer programmes to
workplaces and exposed individuals
organization.
Index values supply the
criteria for priorities
of action
12. A C H E C K - L I S T MODEL FOR THE QUICK EVALUATION
OF RISK E X P O S U R E (OCRA INDEX)
This chapter is devoted to a description of the contents and the criteria for setting up a concise
procedure, useful to identify the presence of upper limb bio-mechanical overload risk by means of a
check list. As already explained in Chapters 3 and 11, the use of the check-list does not substitute for
exposure evaluation, which is more accurate and is only possible by calculating the OCRA index; but
it is still essential during the first phase of risk evaluation within a real company, "in the field".
The check-list describes a work-place and estimates the intrinsic risk, as if the work-place were used
for the whole of the shift by one worker. This procedure makes it possible to find out which work-places
in the company are at risk because of their intrinsic structural characteristics, the risk being classified
as "absent", "light", "medium".
In other words, at the first stage, the check-list supplies an early estimate of the intrinsic risk of each
work-place, but not the exposure indexes for the operators, because that part of the assessment must be
completed later.
Form 1 of the check-list (please see Annex 12.1) includes a short description of the work-place and
of the kind of work done there. It is advisable to find out how many work-places are identical to the one
described, and how many, although not identical, are very similar.
In large companies, it is always useful to carry out analyzes based on similarities, because in this way
it is possible to obtain more information in a shorter time. The analysis system suggested with the
check-list begins with the establishment of pre-assigned scores (higher with the higher risk), for each
of the 4 main risk factors (recovery periods, frequency, force, posture), and for the additional factors.
The sum total of the partial values obtained in this way produces a figure (a score) which then enables
the estimation of the actual risk level.
The recovery periods factor (Form 1)
Form 1 of Annex 12.1 presents six different scenarios whereby the interruptions of the tasks and/or
pauses are distributed during the working shift: a score corresponds to each scenario. The scenario to
choose is the one most similar to the one which is usually (and realistically) used by the workers at that
work-place. Intermediate scores may be used with respect to the suggested ones, if they give a better
picture of the real situation. The resulting number must be written in the proper box (D recovery).
Action frequency (Form 2)
Here too, seven scenarios are offered, each characterized by a score from 0 to 10. Each item describes
the type of arm technical actions in time (slow, quite fast, fast, very fast), relating it to the possibility,
I 12 RISK ASSESSMENT AND MANAGEMENT OF REPETITIVE MOVEMENTS AND EXERTIONS OF UPPER LIMBS
or impossibility, of having short breaks (constant, or inconstant). "Action frequencies per minute" are
also indicated as reference points, to help in the choice of the most representative scenario for the task
under examination at that moment.
It is advisable to estimate the action frequency of the limb which is involved most in the task, by using
a stop-watch, and by observing the operator over 2-3 minutes, counting the technical actions directly (see
Chapter 6). It is also possible to choose intermediate scores with respect to those indicated, if they better
reflect the actual situation. The figure found must be written in the proper box for frequency (r~ frequency).
The use of force (Form 2)
The exertion of force is significant for the upper limb disorders under analysis here, and must be
reported when it occurs periodically at least every few cycles. The first group of questions concerns the
presence of lifting operations for objects weighing over 3 kg, or objects which have to be lifted with the
hand in an awkward position (pinch), and that weigh over 1 kg; they also concern the need to use the
weight of the body to obtain the necessary strength to carry out a given operation, or if parts of the upper
limb must be used as tools, for instance to hit something.
The choice of the representative score is linked to the duration of activities where force has to be
exerted, as indicated above: the greater the presence in the cycle, the higher the value of the numerical
indicator. Here, too, intermediate values can be chosen.
The second and third group of questions include the description of some among the most common
working activities, which require the exertion of intense force (the second group, or block), and the
exertion of a moderate degree of force (the third block), respectively. The activities which must be
described for the two different levels of force are: to pull or push a lever, push buttons, close or open,
press or handle components, use tools. It is also possible to add other items, which may be needed to
represent other actions where the use of force is required.
For those occupational activities requiring the use of "intense" force, the score may range from 4 to
16, according to how long the exertion lasts over the cycle; for moderate force exertion, the score may
range from 2 to 8, but always according to duration.
Here, too, it is possible to choose intermediate scores.
The total score which is representative of force exerted is obtained by adding the scores indicated in
one or more of the three boxes (D FORCE).
In doubtful cases, for instance when describing an activity that requires a moderate use of force, it is
advisable to interview the operator/s directly.
The presence of awkward postures (Form 3)
Five blocs of questions are foreseen for the description of awkward postures: the first four are marked
with a letter (from A to D), the fifth one with number a pre-arrigued score of 3 (letter E). The groups of
questions marked with the letters A, B, C, D each describe a separate joint segment, while the last group
describes the presence of stereotypy, which means the presence of identical gestures (technical actions),
repeated for at least 2/3 of cycle time.
If cycle time is shorter than 15 seconds, stereotypy must still be considered as present (score 3).
Out of the scores for each of the separate joint segments (A, B, C, D), only the highest must be taken,
and it can be added to that of stereotypy, if present (E): the sum total will be the general score for posture
(D POSTURE).
A CHECK-LIST MODEL FOR THE QUICK EVALUATION OF RISK EXPOSURE (OCRA INDEX) I 13
The questions which are used to describe posture for each of the joint segments are very simple. For
the arms, they describe how long the arms are kept at shoulder height, roughly; for the wrist, whether
extreme postures are required; for the elbow, whether sudden movements, or hitting movements, are
required; for the hand, if the type of grip is a PINCH, a palmar grip, or a hook grip.
Additional factors
The presence of additional factors for a relevant part of cycle time must be described (e.g., inadequate
gloves, vibrations, compression on the skin, etc.). The description must also include specifications as to
whether the working pace is either partially or totally imposed by the machine. For each block, or group
of questions, a single answer is allowed: the sum total of the partial scores thereby obtained gives the
additional factor score (n ADDITIONAL).
Calculating the check-list risk index for the work-place
To obtain the final score, it is sufficient to add the partial scores obtained for each of the risk factors: recovery,
frequency, force, posture and additional. Since the numerical values indicated in the check-fist have been
"calibrated" to the multiplier factors supplied for calculation in the more exhaustive OCRA exposure index,
the final check-list value can be interpreted in terms of its correspondence to the OCRA values.
Check-list values up to 6 correspond to OCRA values up to 2 (absence of risk, green area); values
from 6.1 to 11.9 correspond to OCRA values betwen 2.1 and 3.9 (low risk, yellow/red area); values
between 12 and 18.9 correspond to OCRA values between 4 and 7.9 (medium risk, red area): values
equal to, or greater than 19, correspond to OCRA equal to, or greater than, 8, and are indications of very
high risk (red/red area).
If the repetitive task lasts less than 6 hours within one shift (part-time work) it is possible to correct
the value obtained according to actual duration. If the repetitive part-time work only lasts 2 hours, the
final value obtained with the check-list must be multiplied by 0.5; if it lasts 3 to 5 hours, then the final
result must be multiplied by 0.75.
Calculation of the risk index expressed by the check-list according to operators exposure levels
If it is necessary to estimate an initial, indicative exposure index on the workers, the following
procedure must be adopted:
a) if the operator/s works exclusively at the work-place described in the analysis, then the check-list
score given to the work-place is the same as that given to the operators;
b) if the operators works in multiple work-places, implying repetitive tasks, to obtain the specific
exposure index of that operator it is necessary to employ the following formula:
(score A . %PA) + (score B . %PB) + etc.
where "score A" and "score B" are the scores obtained with the check-list for the various work-places
on which the same operator works, and %PA and %PB represent the percentage duration of the
repetitive tasks within the shift.
I I4 RISK ASSESSMENT A N D M A N A G E M E N T OF REPETITIVE MOVEMENTS A N D EXERTIONS OF U P P E R LIMBS
Form 1 ANNEX 12.1
OCRA CHECK LIST

A SHORTENED PROCEDURE FOR THE IDENTIFICATION
OF UPPER LIMB OVERLOAD IN REPETITIVE TASKS
COMPILED BY ....................................................................... Date .....................................................
NAME AND SHORT DESCRIPTION OF WORK-PLACE
NO. OF WORK-PLACE I I
TYPE OF W O R K INTERRUPTION (WITH PAUSES OR OTHER VISUAL CONTROL TASKS) (max. score
allowed = 10). Choose one answer. It is possible to choose intermediate values.
~-I - THERE IS AN INTERRUPTION OF AT LEAST 5 MINUTES EVERY HOUR IN THE REPETITIVE WORK
(ALSO COUNT THE LUNCH BREAK).
I-s - THERE ARE 2 INTERRUPTIONS IN THE MORNING AND 2 IN THE AFTERNOON (PLUS THE LUNCH
BREAK), LASTING AT LEAST 7-10 MINUTES ON THE 7-8 HOUR SHIFT, OR AT LEAST 4
INTERRUPTIONS PER SHIFT (PLUS THE LUNCH BREAK), OR FOUR 7-10 MINUTE INTERRUPTIONS
IN THE 6-HOUR SHIFT.
- THERE ARE 2 PAUSES, LASTING AT LEAST 7-10 MINUTES EACH IN THE 6-HOUR SHIFT (WITHOUT
LUNCH BREAK); OR, 3 PAUSES, PLUS THE LUNCH BREAK, IN A 7-8-HOUR SHIFT.
r4] - THERE ARE 2 PAUSES, PLUS THE LUNCH BREAK, LASTING AT LEAST 7--10 MINUTES EACH
OVER A 7-8 HOUR SHIFT (OR 3 PAUSES WITHOUT THE LUNCH BREAK), OR 1 PAUSE OF AT
LEAST 7-10 MINUTES OVER A 6-HOUR SHIFT.
!-~ - THERE IS A SINGLE PAUSE, LASTING AT LEAST 10 MINUTES, IN A 7-HOUR SHIFT WITHOUT
LUNCH BREAK; OR, IN AN 8-HOUR SHIFT THERE ONLY IS A LUNCH BREAK (THE LUNCH BREAK
IS NOT COUNTED AMONG THE WORKING HOURS).
F0] - THERE ARE NO REAL PAUSES EXCEPT FOR A FEW MINUTES (LESS THAN 5) IN A 7 TO 8-HOUR SHIFT.
i RECOVER Y
NOTES:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .o o , , , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o. .. . . . . . . . . . . . . . .
PLEASE NOTE: it is useful to attach to the Check-list a map of the department, where the position and the number of the
work-place examined can be marked.
A CHECK-LIST MODEL FOR THE QUICK EVALUATION OF RISK EXPOSURE (OCRA INDEX) I 15
Form 2
ARM ACTIVITY AND WORKING FREQUENCY WITH WHICH THE CYCLES ARE PERFORMED (IF
NECESSARY, INTERMEDIATE SCORES CAN BE CHOSEN) (max. score possible = 10) choose one answer.
(state whether left or right arm is involved the most)
I-ol - A R M M O V E M E N T S ARE SLOW, AND F R E Q U E N T S H O R T I N T E R R U P T I O N S ARE POSSIBLE (20

A C T I O N S PER MINUTE).
r-Tl - A R M M O V E M E N T S ARE NOT TOO FAST, ARE C O N S T A N T AND R E G U L A R . S H O R T I N T E R R U P T I O N S
A R E POSSIBLE (30 A C T I O N S PER MINUTE).
I~] - A R M M O V E M E N T S ARE QUITE FAST, AND R E G U L A R (ABOUT 40), BUT S H O R T I N T E R R U P T I O N S
A R E POSSIBLE.
- A R M M O V E M E N T S ARE QUITE FAST AND REGULAR, ONLY O C C A S I O N A L A N D I R R E G U L A R
S H O R T PAUSES ARE POSSIBLE (ABOUT 40 A C T I O N S PER MINUTE).
- A R M M O V E M E N T S ARE FAST. ONLY O C C A S I O N A L AND I R R E G U L A R S H O R T PAUSES ARE
POSSIBLE ( A B O U T 50 A C T I O N S PER MINUTE).
1-81 - A R M M O V E M E N T S ARE V E R Y FAST. THE LACK OF I N T E R R U P T I O N S PACE M A K E S IT DIFFICULT
TO HOLD THE PACE , WHICH IS A B O U T 60 A C T I O N S PER MINUTE.
r]-01 - V E R Y HIGH F R E Q U E N C I E S , 70 A C T I O N S PER MINUTE, OR MORE. A B S O L U T E L Y NO
I N T E R R U P T I O N ARE POSSIBLE
FREQUENCY
PRESENCE OF WORKING ACTIVITIES INVOLVING THE REPEATED USE OF FORCE IN THE HANDS-
ARMS (AT LEAST ONCE EVERY FEW CYCLES DURING ALL THE TASK ANALYSED): 1--1YES I-1 NO
More than one answer can be ticked" add up the partial scores obtained. If necessary, choose
intermediate scores, and then add them together (describe the limb which is most involved, the
same one for which the posture will have to be described).
IF YES:
THIS WORKING TASK IMPLIES: I'TI - ONCE EVERY FEW CYCLES
[] THE HANDLING OF OBJECTS WEIGHING OVER 3 KG
[] GRIPPING BETWEEN FOREFINGER AND THUMB, AND LIFTING, I~! - ONCE EVERY CYCLE
OBJECTS WEIGHING OVER 1 KG (IN PINCH)
[] USINGTHE WEIGHT OF THE BODY TO OBTAIN THE NECESSARY - ABOUT HALF OF THE CYCLE
FORCE TO CARRY OUT A WORKING ACTION I-si - FOR OVER HALF OF THE CYCLE
o THE HANDS ARE USED AS TOOLS TO HIT OR STRIKE SOMETHING
THE WORKING ACTIVITY REQUIRESTHE USE N OF INTENSE FORCE

I~1 - 1/3 OF THE TIME
FOR:
[] PULLING OR PUSHING LEVERS [3] "ABOUT HALF OF THE TIME
[] PUSHING BUTTONS
[] CLOSING OR OPENING 1-81 - OVER HALF OF THE TIME (*)
[] PRESSINGOR HANDLING COMPONENTS
-- NEARLYALL THE TIME (*)
[] USING TOOLS
[]
...................................................................................
THE WORKING ACTIVITY REQUIRES THE USE OF MODERATEFORCE - 1/3 OF THE TIME
FOR:
[] PULLING OR PUSHING LEVERS I~] "ABOUT HALF TH E TIM E
[] PUSHING BUTTONS
D CLOSING OR OPENING [3] - OVER HALF THE TIME
[] PRESSINGOR HANDLING COMPONENTS
n USING TOOLS r~l .- NEARLYALL THE TIME
D ....................................................................................
(*) PLEASE NOTE: The two conditions evidenced are absolutely unacceptable. I I FORCE
I I6 RISK ASSESSMENT A N D M A N A G E M E N T OF REPETITIVE MOVEMENTS A N D EXERTIONS OF U P P E R LIMBS
_,Corm3
PRESENCE OF AWKWARD POSITIONS OF THE ARMS DURING THE REPETITIVE TASK

(highest possible score = 11): I--I RIGHT r--I LEFT I--I BOTH (mark the limb with greater
involvement)
r ~ - THE ARM/ARMS ARE NOT LEANING ON THE WORKBENCH BUT ARE A LITTLE UPLIFTED FOR A
= J
LITTLE OVER HALF THE TIME

[ ~ - THE ARMS HAVE NOTHING TO LEAN ON AND ARE KEPT NEARLY AT SHOULDER HEIGHT FOR
ABOUT 1/3 OF THE TIME
r ~ - THE ARMS ARE KEPT AT ABOUT SHOULDER HEIGHT, WITHOUT SUPPORT, FOR OVER HALF THE
TIME
- THE ARMS ARE KEPT AT ABOUT SHOULDER HEIGHT, WITHOUT SUPPORT, ALL THE TIME
IA
r ~ - THE WRIST MUST BEND IN AN EXTREME POSITION, OR MUST KEEP AWKWARD POSTURES (SUCH
AS WIDE FLEXIONS OR EXTENSIONS, OR WIDE LATERAL DEVIATIONS) FOR AT LEAST 1/3 OF THE
TIME
~ ] - THE WRIST MUST BEND IN AN EXTREME POSITION, OR MUST KEEP AWKWARD POSTURES (SUCH AS
WIDE FLEXIONS OR EXTENSIONS, OR WIDE LATERAL DEVIATIONS) FOR OVER HALF OF THE TIME
~-~ - THE WRIST MUST BEND IN AN EXTREME POSITION, ALL THE TIME IB
~ ] - THE ELBOW EXECUTES SUDDEN MOVEMENTS (JERKING MOVEMENTS, STRIKING MOVEMENTS)

FOR ABOUT 1/3 OF THE TIME
r ~ - THE ELBOW EXECUTES SUDDEN MOVEMENTS (JERKING MOVEMENTS, STRIKING MOVEMENTS)
FOR OVER HALF THE TIME
[~] - THE ELBOW EXECUTES SUDDEN MOVEMENTS (JERKING MOVEMENTS, STRIKING MOVEMENTS)
NEARLY ALL THE TIME IC
GRIP O B J E C T S , P A R T S OR T O O L S WITH F I N G E R T I P S
[~] FOR ABOUT 1/3 OF THE TIME

[ ] WITH CONSTRICTED FINGERS (PINCH); ~] FOR OVER HALF THE TIME
[ ] WITH THE HAND NEARLY OPEN
(PALMAR GRIP) [~ ALLTHE TIME
I-I KEEPING FINGERS HOOKED I ID
PRESENCE OF IDENTICAL MOVEMENTS OF SHOULDER AND/OR ELBOW, AND/OR WRIST, AND/OR HANDS, E
REPEATED FOR AT LEAST 2/3 OF THE TIME (please cross 3 also if the cycle is shorter than 15 seconds)
PLEASE NOTE: use the highest value obtained among the four groups of questions (A,B,C,D) only once, and if possible add
to that of the last question E
i I
9 PRESENCE OF ADDITIONAL RISK FACTORS: only choose one answer per group of questions
~ ' ] - GLOVES INADEQUATE TO THE TASK ARE USED FOR OVER HALF THE TIME (UNCOMFORTABLE, TOO THICK, WRONG
SIZE, ETC.)
~-~ - VIBRATING TOOLS ARE USED FOR OVER HALF THE TIME
~] - THE TOOLS EMPLOYED CAUSE COMPRESSIONS OF THE SKIN (REDDENING, CALLOSITIES, BLISTERS, ETC.)
~] - PRECISION TASKS ARE CARRIED OUT FOR OVER HALF THE TIME (TASKS OVER AREAS SMALLER THAN 2 OR 3 MM)
~-~ - MORE THAN ONE ADDITIONAL FACTOR IS PRESENT AT THE SAME TIME (I.E.............................................................. )
AND, OVERALL, THEY OCCUPY OVER HALF THE TIME
~ ] - ONE OR MORE ADDITIONAL FACTORS ARE PRESENT, AND THEY OCCUPY THE WHOLE OF THE TIME (I.E .................... )
- WORKING PACE SET BY THE MACHINE, BUT THERE ARE "BREATHING SPACES" IN WHICH THE WORKING RHYTHM
CAN EITHER BE SLOWED DOWN OR ACCELERATED
- WORKING PACE COMPLETELY DETERMINED BY THE MACHINE
IADDITIONAL
A CHECK-LIST MODEL FOR THE QUICK EVALUATION OF RISK EXPOSURE (OCRA INDEX) I I7
Form4
PRESENCE OF WORKING ACTIVITIES WITH TASKS ORGANISED IN CYCLES (CYCLE = GROUP OF

ACTIVITIES WITH UPPER LIMB MOVEMENTS THAT REPEAT THEMSELVES EVERY FEW SECONDS
OR MINUTES, AND ARE ALL THE SAME) -it is possible to choose more than one answer
I-I FOR AT LEAST 2-3 HOURS IN THE WORK SHIFT

r-I FOR AT LEAST 4-5 HOURS IN THE SHIFT
I-! FOR 6-8 HOURS, OVERALL, IN THE SHIFT
r-I WORK BY INCENTIVES
I-I USUALWORK OVER H O U R S
CALCULATING THE EXPOSURE INDEX FOR REPETITIVE TASKS
To calculate the task index, add the values in the 5 boxes "Recovery + Frequency * Force + Posture, +
Additional If there is more than one repetitive task carried out during the shift, use the following equation to
obtain the overall score for repetitive work during the shift (% PA = percentage of time for task A during the shift)
(score A x % P A ) + ( score B x % PB) + etc.
I ] EXPOSURE INDEX
PLEASE NOTE: = FOR PART-TIME JOBS LASTING ONLY 2 HOURS IN THE REPETITIVE WORK SHIFT, MULTIPLY THE
FINAL VALUE OF THE CHECK-LIST BY 0.50.
FOR PART-TIME JOBS LASTING 3-5 HOURS IN THE REPETITIVE WORK SHIFT, MULTIPLY THE FINAL CHECK-LIST
VALUE BY 0.75
TASKS CARRIED OUT DURING THE SHIFT, AND/OR NAME OF THE WORK PLACE :
NAME OF WORKPLACE DURATION (min) PREVALENCE OF SHIFT (P)

A ........................................................... ....................................... (PA)
B ......................................................................................................................................... (PB)
C ......................................................................................................................................... (PC)
D ......................................................................................................................................... (PD)
CO-RESPONDENCE OF SCORES BETWEEN OCRA AND CHECK-LIST SCORES
CHECK LIST OCRA
UPTO A 6 GREEN LIGHT, YELLOW/GREEN LIGHT = NO RISK
61 - 119 21 - 3 9 YELLOW/RED LIGHT = LOW RISK
1 2 - 189 4- 79 MEDIUM RANGE = MEDIUM RISK
>19 >8 HIGH RANGE = HIGH RISK

13. E U R O P E A N TECHNICAL STANDARDS IN E R G O N O M I C S
Introduction
Expert groups have now been active for a number of years in Europe, within the CEN (European
Committee for Standardisation), preparing Ergonomics standards. The CEN technical committee that
works in the field of Ergonomics is called CEN TC 122. This Committee has currently started up 10
working groups (WG), listed in Table 13.1.
Table 13.1 - Ergonomics Working Groups within the CEN.TC122
CEN TC 122 Ergonomics- Working Groups (WGs)
~ ANTHROPOMETRY
2. GENERAL PRINCIPLES
3. CONTACT TEMPERATURES
4. BIOMECHANICS
, VIDEOTERMINALS
6. SIGNALS/CONTROLS
7. COMMUNICATIONS
8. PERSONAL PROTECTIVE [ ;QUIPMENT
9. MOBILE MACHINERY
10. MICROCLIMATE
The standards prepared by these working groups and committees stem mainly from a mandate given
to CEN by the European Commission and by the European Free Trade Association (EFTA), to support
the main requirements expressed in the European Directives, and more specifically (within the context
of the issue described here) within the "Machinery Directive" (as it is commonly known), which has
long been enforced in most European Countries.
Ergonomic working systems and machinery means higher worker safety, efficiency, and better
occupational and living conditions. A good ergonomic design also favourably influences working
systems and enhances the reliability of the human operators within it. Whenever a machine is being
designed, its designer must take into account the essential health, safety and ergonomics requirements
as foreseen by the Machinery Directive, and must evaluate the presence of risks.
Table 13.2 - European standards related to the Machinery Directive, for the prevention of musculoskeletal
disorders
Standards Number Physical parameters
Basic human measurements EN ISO 7250 Human measurements

for technological design (BC/CEN/88/13.169)
Anthropometric data EN 547-3 Human measurements
(BC/CEN/88/13.028)
ISO/DIS 15534-3
Anthropometric requirements pr EN ISO 14738 Anthropometric requirements

for the design of workstation
at machinery
Manual handling of objects pr EN 1005-2 Manual handling of loads
associated with machinery (BC/CEN/88/13.035)
Evaluation of working postures pr EN 1005-4 Postures and movements
in relation to machinery (BC/CEN/88/13.355)
Recommended force limits pr EN 1005-3 Force limits
for machinery operation (BC/CEN/88/13.034)
The ergonomic standards which will be discussed here have been prepared to become explicative and
applicative harmonised standards, of the Machinery Directive.
The European standards which are of specific interest for the prevention of musculoskeletal
disorders are listed under Table 13.2.
More recently, a working group has been organized for the preparation of the standard n. 1005-5 on
"risk assessment for repetitive handling at high frequency" (risks from high frequency jobs), which is
also within the B io-mechanics working group, as a harmonised regulation of the Machinery Directive.
The following paragraphs will examine the main points contained within some of these technical
regulations.
R e c o m m e n d e d force limits for machine operations (pr en 1005 - 3)
First of all, it is of basic importance that the operator control operation sequences and machine pace.
Machinery must be designed so that actions requiting the use of force can be carried out optimally with
respect to body and arm posture and to the direction of force application. Moreover, machinery must be
designed so as to enable variations in movements and in the way force is exerted. The risk evaluation
procedure suggested in this standard should be formally conducted on every action carried out during
the use of a given machine. Actions which are less frequent, or with low force exertion, can be evaluated
together and not singly.
The evaluation of risk related to actions requiring force is based on the capability to generate force
on behalf of different user groups and is subdivided into 3 steps.
EUROPEAN TECHNICAL S T A N D A R D S IN E R G O N O M I C S 121
STEP A - D e t e r m i n a t i o n of the capability to develop basic force
Force includes the calculation of maximal isometric force (F b) necessary to carry out specific actions,
with reference to a specific user population. Two alternatives are foreseen: the first uses force capability
values referring to the general European population, and of those values specifically the 15 th percentile
for professional use, and the 1st percentile for domestic use (Table 13.3). The second finds force
capability data in other specific sub-groups, but takes the same percentiles as above as reference data
for professional use (15 th %ile) and for domestic use (1 st %ile).
Table 13.3 - Basic force capability Fb: pre-calculated isometric force capability limits for some common actions
in the domestic and occupational field. These values are only applicable to optimal working conditions
Common actions Action Professional use (N) Domestic use (N)
Manual work (one hand): 250 184

grip
Work of the arm/sitting

9 x + ~. position (one arm)"
v
..~ ~ A + upward(z,+) 50 31
y downward (z,-) 75 44
_ outward (x, +) 55 31
inward (x,-) 75 49
push (y, +):
~ +
z
-
with backrest
without backrest
pull ( y , - ) :
275
62
186
30
with support 225 169

without support 55 28
Whole body work

(standing position):
pushing 200 119
pulling 145 96
Working pedals in a sitting

position with backrest:
ankle 250 154
leg 475 308
STEP B - Weighting with respect to other risk factors
This phase determines force (Fb) weighting according to the other important risk factors, such as speed,
frequency, duration of actions.
a) The multiplier for velocity" if movements are very fast, the capability to develop force is reduced. Fb
must be multiplied by a reduction factor if obvious high-speed movements are present;
10 0.8 m v multiplier factor
NO YES
b) The multiplier for frequency: force reduction multipliers vary according to action time and
frequency, and according to the following grid:
Action time (min)

!1 1.0
0.8 0.5 0.3
< 0.05 Multiplier
Factors mf
~r > 0.05 0.6 0.4 0.2 Not applicable
,. . . .
i ii i i i
< 0.2 0.2-2 2-20 > 20

'Action frequency [min 'i']
c) The multiplier for duration reduces the force factor according to daily duration of the task.
1.0 0.8 0.5 Multiplier factor md
<1 1-2 2-8 Working time with similar actions (hours)
The calculation of the reduction in force capability is therefore obtained with the following formula:
Fbr = F b X m v • mf X m d
EUROPEAN T E C H N I C A L STANDARDS IN ERGONOMICS 123
STEP C - Evaluation of risk tolerability
The risk multiplier described here (mr) takes into account the existing difference between capability and
tolerability of an effort (i.e., capability of physiologically using some bodily tissues, such as muscles,
tendons, joints), by creating a safety margin, and therefore also an acceptability margin. Where it is
adopted, this multiplier gives rise to three risk areas, which should guide the machine designer to
evaluate the presence of risks for potential users.
Risk a r e a s m r
recommended < 0.5

m
The risk of pathologies is minimal
not recommended 0.5-0.7 The risk of pathologies is present
to be avoided > 0.7 The risk of pathologies is obvious and unacceptable
Risk must be analyzed by taking into account all additional factors, i.e., working posture, precision,
vibrations, man-machine interaction, environmental impact.
Evaluation of working postures with reference to the use of a machine (pr EN - 1005-4)
This standard employs a classification by areas to assess the various postures and the movements of the
different body segments:
Acceptable area: health risk is considered as low or negligible for nearly all
healthy adults. No actions are necessary.
Area acceptable under conditions: there is an increased risk for the health of all, or part, of the
population of users: the risk must be analyzed together with all
the factors contributing to its existence, to reduce or remove it.
Unacceptable area: the health risk is unacceptable. The work-place must be re-
designed to improve the working posture.
It is generally said that jobs of long duration and/or jobs with high movement frequency increase
postural occupational risk for machine operators.
Tables from 13.4 to 13.8 show different models of association between health risks and other postural
risk factors.
Table 13.4 - An evaluation model for health risk associated to postures and movements
Health
risk
Static Low frequency High frequency

postures movements movements
1) The trunk: flexion/extension
Table 13.5 - Evaluation of working postures of the trunk (flexion / extension)
Static posture Movements
LOW FREQUENCY HIGH FREQUENCY

(<2 min.) (>2 min.)
ACCEPTAB LE ACCEPTAB LE ACCEPTABLE
II ACCEPTABLE ACCEPTABLE NOT ACCEPTABLE

CONDITIONS IV ",.
(A)
III NOT ACCEPTABLE NOT ACCEPTABLE

ACCEPTABLE CONDITIONS (C) j., .. ,,e II
!!i I
IV ACCEPTABLE ACCEPTABLE NOT ACCEPTABLE
CONDITIONS CONDITIONS (C)
(13)
Condition A= acceptable if the trunk is completely supported: if it is not supported, then acceptability depend on posture,
duration and recovery periods.
Condition B = acceptable if the trunk is completely supported by a high backrest;
Condition C = not acceptable if the machine must be used for long periods
EUROPEAN T E C H N I C A L STANDARDS IN ERGONOMICS 125
2) The trunk is both leaning to one side and rotated
Table 13.6- Evaluation of working postures of the trunk (lateral bending and rotation)
LOW FREQUENCY HIGH FREQUENCY I

(<2 min.) (>2 min.)
AC CE PTAB LE AC CEPTAB LE ACCEPTAB LE
II NOT ACCEPTAB LE NOT ACCEPTABLE

ACCEPTAB LE CONDITIONS
(A)
Conditon A = not acceptable if the machine is used for long periods;
I - Deviation is barely visible;
I I - Deviation clearly visible
3) The upper limbs flexion~extension and abduction
Table 13.7- Evaluation of working postures of the arm/shoulders

(<2 min.) (>2 min.)
-.. m 9
LiI(, ~'
"- ,o.,
I
ACCEPTABLE ACCEPTABLE ACCEPTAB LE II /e

Iv I t ',,0..."
II ACCEPTABLE ACCEPTABLE ACCEPTABLE " ' - . . . . j o-_..,. -"
CONDITION C O N D I T I O N (C)
(A)
III NOT ACCEPTABLE NOT ACCEPTABLE

ACCEPTABLE C O N D I T I O N (B) ',....... : II
',,, . !l~ t
IV NOT ACCEPTABLE NOT ACCEPTABLE
ACCEPTABLE C O N D I T I O N (B) ""---*'1 . . . . .
Condition A= acceptable if the arms are completely supported: if they are not supported, then acceptability depends upon the
duration of the posture, and the recovery period;
Condition B = not acceptable if the machine must be used for long periods;
Condition C = not acceptable if the frequency is > 10 per minute and/or if the machine is used for long periods
4) The cervical spine
Table 13.8- Evaluation of working postures of the neck

II "~l
LOW FREQUENCY
(<2 min.)
HIGH FREQUENCY
(>2 min.)
I '
ACCEPTAB LE ACCEPTAB LE ACCEPTABLE
I1 " - /
ACCEPTAB LE CONDITIONS
(a)
Condition A = not acceptable if the machine is used for long periods

I n
(<2 min.) (>2 min.) t n
!
1
ACCEPTABLE ACCEPTABLE ACCEPTABLE

ACCEPTAB LE CONDITIONS \ x..~,~.--,/
!
i
(A)
I- Deviation is barely visible;

II - Deviation is clearly visible
Anthropometric data (EN 547-3)
The technical standard presents the anthropometric data required to determine the measures and sizes
of workplaces. These data are based on information collected from representative population groups in
Europe, covering about three million individuals. The parameters assessed included both genders.
EUROPEAN TECHNICAL STANDARDS iN ERGONOMICS 127
Table 13.9 - Anthropometric data at the 5 th and 95 th percentile - CEN data
Parameter Definition o f parameter Value o f the Value o f the

5 ~ %ile (mm) 95 ~ %ile (mm)
Shoulder width
(bicromial) 310 430
Hip width (seated) 440
Length of anterior grip 615
Depth of abdomen and

190
backside when seated
Thickness of thigh 125 185
Length from backside

687
to knees
Parameter Definition of parameter Value of the Value of the

5 ~ %ile (ram) 95 ~ %ile (mm)
Length of feet 285
Arm diameter
121 121
H (fixed value)
Height 1881
Height at elbow 930 1195
Vertical distance 665

900
floor/pubic bone
Ankle height 96 96
N (fixed value)
Height when seated 790 1000
O
EUROPEAN TECHNICAL STANDARDS IN ERGONOMICS 129
Parameter Definition of parameter Value o f the Value o f the

5 ~ %ile (mm) 95 ~ %ile (ram)
Height of the eyes 680 870

when seated
Shoulder height 505

when seated
Popliteal height
(under the hollow 340 505
of the knee)
Forearm length
17
S when gripping
Arm length 495

when gripping
Table 13.9 includes the definition of the parameter, its description, together with a picture and the
corresponding value for the anthropometric measurements used in the standards.
The column referring to the 5 th percentile contains values referring to the 5th percentile for the
anthropometric measurements of the European population; likewise the column referring to the 95 th
percentile. Table 13.9 shows the values to be used in the design phase, which may either be those of the
5 tn or 95 th percentiles, depending upon the situations. Sometimes, they may both be necessary.
Anthropometric requirements for designing work-places at machinery (pr EN ISO 14738)
Here are reported some of the preliminary data collected by the CEN/TC 122/WG1 "Anthropometry"
Group, on the anthropometric requirements for designing workplaces at machinery. The measurements
are estimated to cater to the needs of 90% of the European population (from the 5th female percentile
to the 95th male percentile). Table 13.10 regards borderline operating areas for the upper limbs; the
adoption of the "normal" operating areas (A1-B1-C1) instead of the "maximum" areas (A2-B2-C2)
ensures that the upper limbs (especially the scapulo-humeral joint) are not strained.
Table 13.10- Borderline operating areas for the upper limbs (CEN)
Posture Measurement Value(mm)
c2 A1 505 NORMAL WORK

AREA: HEIGHT
I
A= A2 730 MAXIMUM WORK
,~---.--~, / AREA: HEIGHT
B1 480 NORMAL WORK

AREA: WIDTH
B2 1300 MAXIMUM WORK

AREA: WIDTH
< B= = C1 170 NORMAL WORK

290 AREA: DEPTH
I
I S I%"%1
.......
o.*-*-- ~.~ /
t
, 88
C2 415 MAXIMUM WORK
AREA: DEPTH
60*
E U R O P E A N T E C H N I C A L STANDARDS IN ERGONOMICS 131
Tables 13.11, 13.12 and 13.13 supply the main design principles for the workstation. Table 13.11, in
particular, describes the measurements relative to the height of the work surface in the seated position
and the space available (depth and width) for the lower limbs.
Table 13.11 - Seated position: space for the lower limbs
Posture Measurement Value (mm)
HEIGHT-ADJUSTABLE WORK BENCH A 820 HEIGHT-

495 ADJUSTABLE
WORK BENCH
720 NON HEIGHT-

ADJUSTABLE
WORK BENCH
B 790 WORKSTATION
WIDTH
NON HEIGHT-ADJUSTABLE WORK BENCH
C 547 DEPTH AT KNEES
D 882 DEPTH AT FEET
E 285 SPACE FOR

MOVING FEET
UNDER SEAT
F 535 DISTANCE OF
370 SEAT FROM
FLOOR OR
FOOTREST
G 0 HEIGHT OF
165 ADJUSTABLE
FOOTREST
132 RISK ASSESSMENT A N D M A N A G E M E N T OF REPETITIVE MOVEMENTS A N D EXERTIONS OF U P P E R LIMBS
Table 13.12 suggests criteria for modifying the height of the work bench in relation to the different
operational requirements.
Table 13.12 - Criteriafor determining the height of the work bench in the seated position
Operating requirement Posture Height of operating point Height of work surface
PRECISION WORK HIGHER THAN ELBOW HIGH WORKING

(ARMS SUPPORTED) SURFACE POSSIBLE
PRESENCE OF ACTIVE AT ELBOW HEIGHT SURFACE AT ELBOW

ARM MOVEMENTS HEIGHT
IN HANDLING SMALL
OBJECTS
PROCESSING LARGE VARIABLE IN SURFACE BELOW

OBJECTS THAT ARE RELATION TO SIZE ELBOW HEIGHT
NOT EXCESSIVELY OF OBJECT PROVIDED LOWER
BULKY OR HEAVY LIMBS HAVE
SUFFICIENT SPACE
Table 13.13, lastly, describes the different heights required to organize a workstation for the standing
position, in relation to the different operational requirements.
Principles for ergonomic design: interaction between machine design and related working tasks
In the Machinery Directive (89/392/EEC), annex 1, point 1.1.2, ergonomic principles are underlined to
ensure safety and health, together with a rational working process. In the conditions for use which are
foreseen there, discomfort, fatigue and psychological stress of the operators must be reduced to the absolute
minimum, by considering all the ergonomic principles. The standard proposal (pr EN614-2) examined here
EUROPEAN TECHNICAL STANDARDS IN ERGONOMICS I33
Table 13.13 - Height of work surface for standing work positions and space for feet
Posture Measurement Value (mm)
HIGH PRECISION OR VISUALLY DEMANDING SURFACE

HEIGHT
A
Adjustable From 1584
To 1053
Non-adjustable Between
1315 and 1554
MEDIUM PRECISION AND AVERAGE VISUALLY DEMANDING SURFACE

HEIGHT
B
To 960
Non adjustable 1195
B
HANDLING HEAVY OBJECTS AND LOW VISUALLY SURFACE

DEMANDING HEIGHT
C
To 867
Non adjustable 1075
SPACE FOR
d FEET
-ltl" t (HEIGHT) 226
D F
SPACE FOR
FEET (DEPTH)
E 210
HEIGHT From 265

ADJUSTABLE ToO
PLATFORM
WHEN
SURFACE IS
NOT HEIGHT
ADJUSTABLE (F)
helps the designer to implement ergonomic principles and to focus attention specifically on the interaction
between machinery design and working task. This is essential, because the quality of machinery design also
depends upon the operators' capability to carry out established tasks competently and safely.
Implementing ergonomic principles on the machinery and to the working task aims towards the
reduction of discomfort, fatigue, and other negative effects on the workers; it also contributes towards
the optimization of the working system and reduces the risk of negative effects on the workers' health.
The standard's aim is to establish the ergonomic principles and procedures during the design phase
of machinery and of a task. This standard is for machinery designers, but it is also useful for those who
deal with machinery use and users, i.e., managers, organisers, etc.
The standard requires:
- Respecting some guidelines when designing working tasks;

- Adopting a "step-by-step" method when designing each task;
- Checking the results obtained against the guidelines.
When the designer is designing machinery and the consequent working task, he/she must make sure
that all the following ergonomic characteristics are complied with, with reference to the target user.
More specifically, when designing a process, the designer must:
a) know and refer to the experience, capabilities and skills of the target user population;
b) make sure that work tasks are clearly identifiable as work units, having a clear beginning and end,
and not isolated fragments of such tasks;
c) ensure that the work tasks are identifiable as a significant contribution to the resulting final product;
d) ensure the right mix of skills, capabilities, and activities;
e) provide an appropriate degree of freedom and autonomy to the operator;
f) provide sufficient feedback on task performance in terms meaningful to the operator; i.e.,
information on task execution shall be available to the operator, to check if the targets have been
attained, and if the work has been carried out adequately. This will also include information on
mistakes, and alternative choices;
g) provide the opportunity to practise and develop skills and capabilities, and acquire new ones;
h) avoid o v e r - or under-load of the operator, which might lead to excessive and unnecessary strain,
fatigue and or to errors. The activities which are particularly important in this sense, and which must
be designed in such a way to avoid all these consequences, are: frequency, duration and intensity of
perceptive, cognitive and motor activities;
i) Avoid repetitiveness, which may lead to imbalanced work strain and to physical disorders as well as
to sensations of monotony, boredom, lack of satisfaction. Short cycles should be avoided. The
operator must have an adequate variety of tasks or activities.
If repetitive tasks cannot be avoided:
- performance time shall not be determined solely on the basis of average times as measured and
estimated in normal conditions;
- allowances shall be given for deviation from the "normal" conditions;
- very short cycle times shall be avoided;
- the operator must have the possibility to work at his/her pace, rather than at a set pace;
- avoid working on moving objects;
- avoid working alone, without the opportunities of having social and functional contacts;
EUROPEAN T E C H N I C A L STANDARDS IN ERGONOMICS I35
- vision, noise level, the distances and autonomy between work-places, must all be taken into due
consideration when machine spaces, position and function are defined, together with those of related
equipment.
All of these characteristics shall not be violated whenever a machinery is being designed. If it were
not possible to satisfy all requirements, then the machine and the related tasks must be structured as
closely as possible to the objectives.
The appropriate methodology for task design is defined as a process which include the following
steps:
a) general design targets are defined;

b) functions analysis is carried out;
c) consequent functions allocation is carried out;
d) consequent tasks are specified;
e) tasks are assigned to the operators.
It is very important to point out that the designer must tackle the subsequent steps by taking into
account both the ergonomic principles and the need to foresee the consequences of the various choices
(in terms of productivity and health).
During phase c), function allocation, the distribution of work between machinery and operator must
be decided and, if necessary, more alternatives must be allowed.
During phase d) (task specification) each working task foreseen for the operator which emerges from
function allocation must be planned out and specified in detail. At the same time, all the corresponding
technical solutions, including the man-machine interface, must be specified. The aim of task
specification to establish what kinds of tasks and sub-tasks the operators will have to carry out, and to
collect information on the needs related to qualification, workload distribution and possible risks.
During this delicate phase, the designer must:
- take into account similar situations which have already been designed ergonomically;
- specify what the operator must do, when, with whom, and with what type of working equipment,
when he/she is operating the machine;
- describe and evaluate the organizational characteristics that are linked to the execution of the working
task: e.g., the degree of force required for the execution of the task, task frequency, timing and task
sequence, difficulty in learning the task, difficulty in executing the task, risks related to task execution.
Specifications must lead to a clear design of the worktask and the risk which each task implies for
the operator; moreover, they must supply adequate task distribution for each single operator.
The results of this kind of specification must be compared with the basic task design principles.
The designer must entrust the task to the operator with a clear specification of the number of
operators required, and with a well-balanced distribution of the workload among all the operators.
The designer will be called upon to evaluate task design with respect to machine use, not only during
the design phase itself, but also during the implementation and operational phases.
The methods and criteria whereby this evaluation is carried out also depend on the degree of
complexity of the process designed, and they must be clearly explained and available for reference.
Among the methods used, some envisage the use of the following "tools'" group discussion, interviews,
questionnaires, check-lists, observational studies, criticality studies (accidents), psychometric
evaluations with the use of standardised scales (scoring systems).
14. GUIDELINES FOR DESIGNING JOBS FEATURING REPETITIVE TASKS
I n t r o d u c t i o n
When both exposure assessment and the study of work-related musculo-skeletal diseases have revealed
a significant risk associated with repetitive and/or strenuous movements of the upper limbs, the need
arises to implement specific measures aimed at re-designing jobs and procedures. These measures are
often urgent and complex. Their efficacy depends on three types of coordinated and virtually
simultaneous actions being carried out: structural modifications, organisational changes and personnel
training. Whilst the structural measures are almost universally accepted and widely recommended,
actions involving organisational changes do not always meet with unanimous consent, nor does the
scientific literature provide concrete examples. Instead it merely supplies general and routine advice
such as" "reduce excessively high job frequencies", or "introduce adequate breaks or job alternatives".
This chapter aims to provide some concrete guidelines for re-designing jobs and preventing disorders
caused by repetitive movements of the upper limbs. Reference will be made to the three areas mentioned
above, and specific indications will be given for each area, based on the abundant literature already
available on structural modifications. A section is also devoted to the subject of possible organisational
changes, already investigated and applied in some field experiments; lastly, guidelines are supplied for
Table 14.1 - Guidelines for prevention: general description of possible measures
Structural modifications
- The use of ergonomic tools.
- An optimal arrangement of the work station, furnishings and lay-out.
- Improve aspects related to the excessive use of force, awkward posture and localized compressions.
Organizational modifications
- An ergonomically designed job (speed, pauses, alternating job with other tasks or parts of tasks.
Improve aspects related to:
- Movements performed frequently and repetitively for prolonged periods.
- Absence or inadequacy of recovery periods.
Training and re-training

- Suggestions concerning breaks.
- Appropriate information on specific risks and injuries.
- Concrete methods for performing tasks and utilizing proper techniques.
The above are all additional to the other interventions.
personnel training and re-training programes designed to support the previous two classes of actions,
i.e. structural and organisational.
Table 14.1 shows the three classes of measures, with summaries of their aims and methods.
Structural measures
These primarily concern ways of finding an optimal arrangement for the workplace, furnishings and the
overall lay-out of the environment and ergonomic work tools. In general, these measures aim to improve
aspects related to awkward posture and movements, localised compressions of the anatomical structures
of the upper limbs, and the use of excessive force.
Structural measures thus seek to reduce the consequences of important risk factors like "posture" and
"force", and of many other additional risk factors.
Criteria for limiting the risk factor "posture"
As far as the "posture" risk factor is concerned, the main principle to be kept in mind is to avoid
prolonged movements or positions that force the joints to exceed 50% of their maximum range (Drury,
1987). Re-designing the job, in this case, means allowing the worker to maintain posture or joint motion
below 50% of the maximum specific range for each joint.
In order to ensure the correct position of the upper limbs, it is first essential to correctly design the
workplace, emphasising (see chapter 13):
a) suitable work bench height whether standing or sitting;

b) suitable chair height for seated positions;
c) suitable operating areas for the upper limbs.
Figures 14.1 to 14.4 supply the main design recommendations (Eastman Kodak C., 1983; Putz
Anderson, 1988) in order to prevent awkward positions and/or movements harmful to the shoulder
(Figure 14.1), elbow (Figure 14.2), wrist (Figure 14.3), hand and fingers (Figure 14.4).
Criteria for limiting the risk factor "force"
The main principle involved here is to avoid overstraining the muscles, as can be assessed by
subjective perception during the execution of a task (demand for more force than the individual can
develop). It should also be noted that when the upper limbs, especially the wrist and hand, have
adopted an awkward posture, the ability of the muscles in the strained segment to apply force is
drastically reduced.
For example, the force that can be developed in pinching movements is only 25% of the total grip
force of the hand in such cases; moreover, grip force gradually diminishes as the wrist departs from the
anatomical position (Figure 14.5).
In order to intrinsically reduce excessive strain, the following recommendation can be made:
- avoid even occasional contractions exceeding 50-60% of the maximum individual capacity (score of
5-6 on the Borg scale);
G U I D E L I N E S FOR DESIGNING JOBS F E A T U R I N G REPETITIVE TASKS 139
Figure 14.1
Principal recommendations for (re)designing workstations" how to avoid harmful postures and movements for the
scapulo-humeral joint (shoulder) (3) (4).
TO PICK UP THE PIECE, THE ARM IS TO OPERATE THE LEVER, THE ARM
ABDUCTED 60-70 ~. IT THEREFORE EXCEEDS IS FLEXED MORE THAN 80 ~.
BY 50% THE MAXIMUM RECOMMENDED
RANGE (45~ THE LEVER MUST BE LOWERED OR,
THE PIECES TO BE GRASPED MUST BE BETTER STILL, REPLACED WITH
PLACED CLOSER. PUSH-BUTTONS.
>45*
~ 1 7 6 1 7 6
TO PLACE THE WORKED PIECE, THE ARM IS THE ARMS ARE KEPT RAISED AT AN
STRETCHED MORE THAN 20 ~. ANGLE OF OVER 45 ~ FOR AT LEAST
THE PLACE WHERE THE PIECE IS DEPOSITED 2/3 OF THE JOB CYCLE.
MUST BE REPOSITIONED ALONGSIDE THE ARM-RESTS FOR THE FOREARMS
WORKER. MUST BE PROVIDED.
IN GENERAL:
9 DO NOT EXCEED 50% OF THE RANGE OF JOINT MOTION FOR SIGNIFICANT PERIODS OF TIME
(1/3 OF THE CYCLE);
9 DO NOT KEEP THE LIMBS RAISED WITHOUT SUPPORT AT AN ANGLE OF 45 ~ FOR PROLONGED
PERIODS OF TIME (2/3 OF THE CYCLE);
9 DO NOT REPEAT THE SAME ACTION FOR PROLONGED PERIODS OF TIME (2/3 OF THE CYCLE).
- no muscle-tendon unit should exert more than 15% of its m a x i m u m capacity in any given shift (score
of 1.5 on the Borg scale, calculated as a weighted score for the duration of the task).
The lower the degree of muscular exertion, the longer the permitted duration of the exertion
(exponential ratio).
In addition, the lower the degree of muscular exertion, the greater the number of technical actions
(frequency) that can be made in performing a repetitive task with consequent positive repercussions on
"productivity" levels.
Figure 14.2
Principal recommendations for (re)designing workstations: how to avoid harmful postures and movements for the
elbow joint (3) (4) (6).
IN HANDLING THE PIECE, THE HAND IS IN PICKING UP AND POSITIONING THE PIECE,
FORCED INTO AN EXTREME SUPINATION THE FOREARM IS FLEXED MORE THAN 60 ~.
(OVER 60 ~
THESE MOVEMENTS MUST BE RE-DESIGNED THE LATERAL GRASPING POINTS MUST BE

TO AVOID SUPINATION. BROUGHT CLOSER.
IN GENERAL:
9 DO NOT EXCEED 50% OF THE MAXIMUM JOINT MOTION RANGE FOR SIGNIFICANT PERIODS OF
TIME (1/3 OF THE CYCLE).
9 DO NOT REPEAT THE SAME ACTION FOR PROLONGED PERIODS OF TIME (2/3 OF THE CYCLE).
Generally speaking, it is possible to reduce the need for force by using power-driven tools,
mechanical grippers and holders, more efficient levers in positions better suited to the stronger muscle-
tendon units and, lastly, by automating the entire action.
Instruments and tools must meet a series of requirements in order to limit the above mentioned risk
factors -"posture" and " f o r c e " - thus also reducing the risk of accidents in the workplace.
An ergonomic instrument or tool should:
- avoid having to deviate the wrist by more than 50% of its normal range;
- avoid repetitive movements using a single finger;
- avoid handpieces requiting awkward grips for the development of force;
- avoid pulling movements and striking actions;
- avoid localised compressions;
- avoid the transmission of mechanical vibrations.
Ergonomic instruments or tools should also be coated with a slip-proof finish and should neither
conduct heat nor have sharp edges, pointed tips or potentially harmful shapes.
G U I D E L I N E S FOR D E S I G N I N G JOBS F E A T U R I N G R E P E T I T I V E TASKS 14 1
Figure 14.3
Principal recommendations for (re)designing workstations" how to avoid harmful postures and movements for the
wrist joint (3) (6).
~ "45~
+ 25"
D
I E~TO
IN ~IIICr
, EXION
F
~ J EL~NSION
IN OPERATING THE LEVER, THE WRIST IS WHEN USING THE TOOL, THE WRIST IS BENT
FLEXED AND EXTENDED TO AN ANGLE RADIALLY TO AN ANGLE GREATER THAN 15 ~.
GREATER THAN 45 ~.
IT WOULD BE ADVISABLE TO REPLACE THE
LEVER WITH A PUSH-BUTTON.
45 ~
E~NS
IN GENERAL:
9 AVOID ADOPTING POSITIONS THAT ARE
MORE THAN 50% ABOVE THE MAX. JOINT
RANGE FOR PROLONGED PERIODS OF TIME WHEN USING THE TOOL, THE WRIST IS
(1/3 OF THE CYCLE). FLEXED TO AN ANGLE GREATER THAN 45 ~.
9 AVOID REPEATING THE SAME MOVEMENT
FOR PROLONGED PERIODS OF TIME.
i ..
IN SUCH CASES, THE TOOLS SHOULD BE
REPLACED BY OTHERS WHICH ALLOW THE
WRIST TO BE KEPT VIRTUALLY STRAIGHT
(ANATOMICAL POSITION).
I42 RISK ASSESSMENT A N D M A N A G E M E N T OF REPETITIVE MOVEMENTS A N D EXERTIONS OF UPPER LIMBS
Figure 14.4
Principal recommendations for (re)designing workstations: how to avoid harmful postures for the fingers and hand
(4) (6).
/,.'" .,j" -.,,
PALMAR PINCH
PALMAR
GRIP
IT IS GENERALLY ADVISABLE TO AVOID

ADOPTING THE GRIPS SHOWN HERE
SINCE THEY DO NOT ALLOW THAN
HOOK GRIP HAND TO DEVELOP ADEQUATE FORCE.
(NARROW-DIAMETER
HANDLE)
THE POWER GRIP SHOWN HERE ALLOWS THE HAND TO DEVELOP THE
UTMOST FORCE.
IN THIS GRIP, THE THUMB IS IN DIRECT OPPOSITION TO THE FINGERS
WHICH THUS TOTALLY ENCLOSE THE OBJECT AND CURVE AROUND ITS
SHAPE.
THE PINCH GRIP SHOWN HERE IS CHARACTERISED BY THE OPPOSITION

OF THE THUMB TO THE DISTAL JOINTS OF THE FINGERS.
THIS GRIP CAN DEVELOP ONLY 25% OF THE HAND'S TOTAL GRIP FORCE:
IT IS THEREFORE INTRINSICALLY AT GREATER RISK.
IN GENERAL:
P. AVOID USING THE PALMAR PINCH AND GRIP AND HOOK GRIP FOR SIGNIFICANT PERIODS OF
TIME (1/3 OF THE CYCLE).
I, AVOID ADOPTING THE LESS FAVOURABLE GRIPS FOR PROLONGED PERIODS OF TIME (2/3 OF
THE CYCLE).
I,. AVOID REPEATING THE SAME MOVEMENT INVOLVING THE SAME FINGER/S FOR PROLONGED
PERIODS OF TIME (2/3 OF THE CYCLE).
GUIDELINES FOR DESIGNING JOBS FEATURING REPETITIVE TASKS 143
Figure 14.5
Wrist and hand postures which give rise to significant loss of grip force (4) (6).
2 5 % O F M A X G RIP F O R C E
9 4p
t, o ~lgi i ' ~
65% OF MAXGRIP FORCE
PINCH GRIP
OBLIQUE POWER GRIP (the fingers are curved around
the handpiece, except for the thumb which is stretched out
to stabilise the grip.
A) SIGNIFICANT LOSS OF GRIP FORCE ASSOCIATED WITH DIFFERENT TYPES OF GRIP.

RADIAL DEVIATION NEUTRAL
25 ~ 0~
80% OF MAX FORCE 100% OF GRIP FORCE
NEUTRAL
0o
a! 100% OF GRIP FORCE
FLEXION
EXTENSION
45 ~
60% OF MAX FORCE 45 ~
75% OF MAX FORCE
F L E6X5 I~O N
45% OF MAX FORCE

ULNAR DEVIATION
40 ~
75% OF MAX FORCE
B) SIGNIFICANT LOSS OF GRIP FORCE

ASSOCIATED WITH DIFFERENT WRIST
POSITIONS.
Organizational measures
Measures typically involving changes to the organisation of labour become necessary when it has been
ascertained that jobs feature excessively frequent technical actions and/or inadequate functional
recovery periods.
I44 RISK ASSESSMENT AND M A N A G E M E N T OF REPETITIVE MOVEMENTS AND EXERTIONS OF UPPER LIMBS
Measures designed to improve these two fundamental risk factors (frequency and recovery periods)
can often interfere with "productivity" and therefore are less readily accepted by employers.
The authors have recently acquired a considerable amount of practical experience which may supply
useful suggestions for embarking on the organisational restructuring of specific working activities.
In a large metal-working factory featuring assembly lines, a significant prevalence of upper limb disorders was
detected (Carpal Tunnel Syndrome, tendinitis, etc.) in most cases attributable to repetitive tasks performed with
excessive frequency.
On the advice of the local health unit, the company asked the authors to carry out a detailed risk analysis in
order to develop options for re-designing workstations more ergonomically.
The exposure assessment identified the following problem areas:
a) high-frequency actions (more than 40 technical actions per minute);

b) in general, minimal use of force: force peaks of between 4 and 5 on the Borg scale were demanded by only a
few actions that could be easily singled out during the job cycle. In almost all cases, the company quickly found
specific solutions for bringing the use of force within acceptable limits;
c) posture seldom "extreme" and therefore easily corrected by making some structural modifications to the
workstation;
d) recovery periods taken primarily for physiological reasons rather than for the purpose of alternating jobs. The
daily schedule included two morning breaks (10 and 15 minutes respectively), a 30 minute lunch break, and one
10 minute afternoon break. One simple change involved optimising the recovery periods: the total duration of
the physiological breaks was already sufficient; by simply redistributing the breaks, it was possible to ensure
adequate recovery periods, without altering their overall duration. The company undertook to redistribute the
physiological breaks (35 minutes = 10' + 15' + 10') so as to obtain 4 breaks (two in the morning and two in the
afternoon) of 8/10 minutes each.
In this case, the last problem that needed solving was the high frequency of the technical actions.
The first and most obvious intervention (most obvious for the ergonomist, but certainly not for the
company!) was to reduce the pace of the task (with a consequent decline in "productivity"). This
solution was kept as a last resort, in the event that the "frequency" of the task could not be reduced by
any other means.
After several meetings with the production engineers, safety officers and supervisors, this first
objective was defined to identify methods for reducing the number of technical actions required to
complete a job cycle, without compromising output.
In other words, this meant optimising- in terms of quality and quantity- the technical actions
needed to complete the cycle characterising the task.
The production engineers, particularly those directly involved in designing how tasks are carried out
(e.g. in accordance with "Methods and Time" procedures) were already quite proficient in seeking to
optimise the actions that needed to be performed to complete a task.
However, their experience and research was generally aimed at reducing the number of actions
performed and shortening the duration of the task, thereby increasing the number of pieces
produced.
Through valuable co-operation between the ergonomist and the production engineer, it was possible
to use the fundamental experience of the engineer not to enhance "productivity", but to improve
working conditions and thus the health of the workers.
Having established, in agreement with the management and plant engineers, that the aim was to
reduce the number of actions without reducing output, the first step was to identify the means and
methods of achieving the objective.
G U I D E L I N E S FOR D E S I G N I N G JOBS F E A T U R I N G R E P E T I T I V E TASKS 145
The films shot for the exposure assessment were analysed by a task force comprising the ergonomist,
the production engineer and plant supervisor. Each task was revised several times, after critically
examining the way the technical actions were performed.
In order to reduce the number of actions contained in a cycle, the procedure described hereunder in
5 steps and summed up in Table 14.2 was used.
Step A- analysis of "useless" technical actions

During this phase, it is decided whether all the technical actions actually observed to be performed
are strictly necessary. It is thus possible to single out "useless" actions performed by the operator as
actions which could be designed out of the task.
In practice, this means:
- detecting any "useless" actions added by the operator:

e.g. when assembling a piece, the operator occasionally strikes the piece more often or screws the piece more
tightly than required: two strokes might be necessary, while the operator actually performs 4-5-6 strokes.
In this case, the operator can be trained to use only the required useful actions.
- detecting whether any actions added by the operator are entirely arbitrary or in fact conceal a manual flaw:
e.g. a faulty pin does not fit snugly so the operator needs to strike it several times to force it into the correct position.
Once the manual flaw has been identified, it can be eliminated, and the number of actions required
to perform the task can be reduced.
- detecting "obsolete" actions.
In the course of time, assembly lines may undergo small changes to the machinery or to the product,
rendering certain actions "obsolete". Therefore it is extremely useful to check the way operators
perform their tasks whenever machinery or products are modified.
Table 14.2 - Brief recommendations for reducing the frequency of technical actions
AVOID USELESS ACTIONS: ADDED ARBITRARILY BY THE WORKER

DUE TO MANUFACTURING FLAWS
DUE TO OBSOLETE TECHNOLOGIES
DISTRIBUTE TASKS BETWEEN BOTH LIMBS
REDUCE THE REPETITION BY PROCESSING PRE-ASSEMBLED PIECES

OF IDENTICAL ACTIONS: BY INTRODUCING SEMI-AUTOMATIC STEPS
BY REPLACING MACHINING JOBS WITH HI-TECH SOLUTIONS
REDUCE AUXILIARY ACTIONS: ~ BY CREATING INTERSECTIONS BETWEEN THE CONVEYOR

BELT AND THE WORK BENCH
SPLITTING JOBS
Step B: analysis of upper limb use when performing technical actions

Once all "useless" actions have been eliminated, the next step is to optimise the distribution of the
various actions between the two upper limbs.
Workers often tend to favour their dominant limb. Simple low-precision actions (e.g. picking up
workpieces and placing them on the machining line) may be performed equally by both limbs, thus
reducing the frequency with which the dominant limb is used.
Step C: analysis of "identical" technical actions

During this phase, it is seen whether workers are repeating identical technical actions for a significant
portion of the job cycle. As already mentioned, repeating the same joint motions is likely to overload
specific muscle-tendon units.
Together with the engineering staff, it was observed that the repetition of identical technical actions
can often be avoided by introducing a specific mechanical device:
e.g. the worker picks up a number of screws and places them one at a time (total 10) into position, giving each
one a single manual turn with the fingers to secure it.
In this case, the use of an automatic screwdriver would be useful.
E.g. manual polishing jobs: in this case, an electric polisher can be used.
By virtue of their being identical, these sets of actions are generally performed at very high speeds
and therefore significantly increase the total frequency of the action within the job cycle. On the other
hand, when identical technical actions have been identified but no suitable tools can be introduced and,
at the same time, the action frequency considerably increases the total frequency, one of the following
solutions may be adopted:
- eliminate the specific manufacturing step altogether, by having the part arrive pre-assembled elsewhere
(simple solution; but make sure this does not lead to another high-risk job being created);
- introduce a semi-automatic step to replace the technical actions;
- re-examine the phase scientifically to find alternative solutions capable of fully by-passing the
specific action sequence (hi-tech solution that often also improves the product);
e.g. before welding, wire terminals must be gathered together and wound using a pinch grip and very rapid
prono-supination movements of the elbow. It was discovered that a different type of weld does not require the
wires to be manually pre-wound.
Step D: analysis of "auxiliary" actions

It must be checked whether in passing from one cycle to the next, any "auxiliary" actions are
performed:
e.g. in order to start assembling several components onto a new piece (cycle start), the worker must first remove
the component from the conveyor belt, rotate it, set it down on his/her work bench and then start the actual
assembly. The worker then picks up the finished piece, rotates it and replaces it on the conveyor belt.
This type of movement from the belt to the bench and vice versa can often cause physical strain.
It is generally useful to have the conveyor belt and operating areas cross each other in such a way as
to avoid the worker having to pick up and replace pieces.
It is equally helpful for the piece to reach the worker "facing the fight way" so as to minimise handling.
G U I D E L I N E S FOR DESIGNING JOBS F E A T U R I N G REPETITIVE TASKS I47
Table 14.3 - Monitoring frequency of manual actions (number of actions per minute) before and after the re-design
of an assembly line: each box correspond to one workstation
RIGHT SIDE
MIN. 20
AVE. 31 AFTER RE-DESIGN
MAX 38
MODE 35 Frequency
S.D. 4.6
BEFORE RE-DESIGN
MIN. 15
AVE. 38
MAX 56
MODE -
S.D. 11.5
Frequency
LEFT SIDE
MIN. 20
AVE. 29 AFTER RE-DESIGN
MAX 38
MODE 33
Frequency
S.D. 6"
BEFORE RE-DESIGN
MIN. 10
AVE. 31
MAX 62
MODE 26
S.D. 12.2
Frequency
Step E" when jobs need to be split

Despite carefully reviewing actions, sometimes their frequency remains excessively high (60/70
actions/minute). In such cases, jobs could need to be split.
Table 14.2 sums up the procedures identified and adopted by the authors in conjunction with the team
from the factory, in an effort to reduce action frequency.
Example 1: A c t i o n f r e q u e n c y i m p r o v e m e n t
Although the modifications introduced by the company to redesign an entire production line are not
exhaustive, the procedures achieved considerable improvements: the actions diminished in frequency
from 38-40/minute (line average) to 30/minute.
Table 14.3 features a graph produced by the engineering personnel depicting the monitoring of
technical actions before and after redesigning the entire production line. The action frequency levels are
shown for each workstation along the assembly line, and indicate the fight and left limbs separately.
Mean frequencies and relative standard deviations were also calculated. As can be seen from the
results, not only did the mean frequency levels decrease (in particular for the right hand), but the
standard deviations also dropped dramatically: in other words, the most dangerous frequency peaks
were eliminated.
It should be kept in mind that a frequency of 30 actions per m i n u t e - with no other risk factors
i n v o l v e d - is assumed to be the highest acceptable frequency. Several workstations still feature
frequency levels higher than this with the presence of other risk factors.
In this case, it is necessary to at least introduce hourly job switches, so that the workers performing
jobs that might still potentially overload the upper limbs, can alternate with less strenuous jobs.
Since the same manufacturing line features workstations with relatively low action frequencies, it
will not be difficult to arrange for workers to switch jobs regularly. Job switching is very useful for
reducing the risk of exposure to the frequency factor, since it enables workers:
- to alternate between workstations at low risk and workstations at higher risk for frequency;
- to alternate between workstations in which the use of the upper limb changes (left and right).
In addition to alternating jobs in order to prevent disorders due to repetitive movements, the presence
of adequate recovery periods is of critical importance. Elsewhere in this volume it is extensively
reported that rest periods can be optimised by ensuring a ratio of work periods to recovery periods of
5:1, within each hour of repetitive work.
Often factories schedule long enough recovery periods (i.e. actual breaks and/or non-repetitive tasks)
but these are poorly distributed throughout the duration of the repetitive task.
It is therefore suggested to:
- optimise the distribution of official breaks: it is preferable to shorten each individual break, but to
increase their frequency;
- arrange, if possible, for rest periods to be scheduled at the end of an hour of repetitive work;
- avoid the scheduling of rest periods too close to meal breaks and the end of shifts, in order to
"exploit" these as recovery periods;
- rotate workers in non-repetitive tasks, so as to obtain an optimal distribution of repetitive and non-
repetitive tasks, thus ensuring a good work/recovery period ratio.
In some work situations in which the upper limbs are particularly overloaded, it may be advisable, if
not essential, to increase recovery times in order to bring about a drastic and prompt reduction of the
relevant risk.
Of course this modification will represent an expense for the company, but nevertheless may turn out
to be extremely useful when the incidence of workers affected by WMSDs (xxx new cases per year) is
high and when technological difficulties make general system overhauls a time-consuming prospect.
G U I D E L I N E S FOR DESIGNING JOBS F E A T U R I N G REPETITIVE TASKS I49
Accordingly, it is worth looking at an actual application, in which regular 8-minute breaks were
introduced every hour on an assembly line at high risk for biomechanical overload. Data is supplied
concerning the improvements in the health status of the workers.
A large metalworking factory brought in intermittent health monitoring programmes five years
previously for workers exposed to the risk of upper limb biomechanical overload. The workers are on
an assembly line and were exposed to a mean OCRA risk index of 5.4 at the start of the job re-design
project. Between 1996 and 1999 all the assembly line workers were given a medical examination
approximately once a year to assess the presence of upper limb WMSDs. The disorders included carpal
tunnel syndrome (65%), wrist/hand tendinitis (25%), shoulder tendinitis (10%). Table 14.4 shows the
incidence of new cases of upper limb WMSDs/year starting from 1996.
It can be noticed that before the jobs were re-designed the incidence was very high (15.9%). The first
jobs, those that were at highest risk, were re-designed between 1996 and 1997, primarily to reduce the
use of force and improve posture in the workplace" the incidence immediately dropped to 8.7%.
Between 1998 and 1999, while waiting for new high-tech lines to be installed, it was decided to
introduce an 8-minute break every hour, in order to further reduce the risk of biomechanical overload
and bring down the incidence of WMSDs even more significantly. During an approx. 8-hour shift with
one meal break, the new schedule introduced 6 short breaks at the end of each hour of work, except for
the hour in which the meal was taken and the last hour of the shift.
The incidence levels reported did in fact drop dramatically, from 8.7% to 3%. The factory will
continue to adopt this temporary solution until the new machinery has been installed.
Table 14.5 shows a flow diagram relative to a study on risk factors which, consequently, also involves
designing modifications in terms of their priority - the aim being to optimise the results and minimise
undesirable effects on "costs" and productivity.
Alongside redesigning jobs according to predefined priorities, it is also necessary to embark on a health
monitoring programme for the workers. This will not only keep track of the effectiveness of the
modifications introduced, but also in some cases highlight the need to re-prioritise decisions and changes.
Training programmes
Different types of training programmes must be tailored to the following three categories of employees:
- factory workers (operatives);

- production engineers and supervisors (process generators);
- management (strategic organisers).
a) T r a i n i n g f o r f a c t o r y w o r k e r s .
Workers must be informed of the risks and damage associated with repetitive tasks, in order to justify
and motivate the need for such tasks to be performed correctly and in the proper order.
Workers must therefore be suitably trained to:
- perform tasks in the required order;

- use both limbs whenever possible;
- avoid adding useless actions;
- grip objects correctly;
- notify the supervisor whenever new actions need to be performed;
- contact the health officer as soon as "early warning signals" are noticed.
I5 ~ RISK ASSESSMENT AND MANAGEMENT OF REPETITIVE MOVEMENTS AND EXERTIONS OF UPPER LIMBS
Table 14.4- Prevalence of WMSDs new cases per year in foreman ME from 1996 to 1999
N. new pathological Total number of exposed Incidence of WMSDs

cases per year workers per year
1996 26 163 15.9

1997 18 218 8.7
1998} 198 } 3
1999 12 203
Table 14.5 - Flowchart showing redesign priorities
STUDY OF RISK FACTORS IN CYCLE
1. STUDY OF ACTIONS REQUIRING USE REDUCTION IN USE OF FORCE

OF FORCE - by introducing appropriate tools
- improving existing tools
- improving posture
2. STUDY OF ACTIONS FEATURING REDESIGNING WORKSTATIONS TO KEEP

EXTREME POSTURES POSTURE AND MOVEMENTS BELOW 50% OF
THE MAXIMUM JOINT RANGE
3. STUDY OF HIGH FREQUENCY TECHNICAL REDUCTION OF THE NUMBER OF TECHNICAL
ACTIONS ACTIONS WITHIN THE CYCLE
4. STUDY OF ADDITIONAL RISK FACTORS REDUCTION OF THE HARMFUL EFFECT OF
ADDITIONAL FACTORS
- by using more appropriate tools
- etc.
5. STUDY OF DISTRIBUTION OF RECOVERY ADAPTATION OF BREAKS AND/OR

PERIODS ALTERNATIVE TASKS TO PERIODS FEATURING
REPETITIVE TASKS
- by increasing recovery times
- better distributing recovery periods
The worker must also be trained to use breaks correctly especially when the management of breaks
is discretionary.
b) Training for production engineers and supervisors.

As for the previous category, the training process is based on a clear understanding of the specific
risks and injuries as well as the medico-legal implications associated with occupational diseases.
Engineers must be well trained to "detect" risk factors associated with repetitive tasks, and to
redesign old jobs or design new jobs in order to avoid them.
In the light of the continuing evolution taking place in modern manufacturing systems, production
engineers must realise that the process of checking for risk factors must go hand in hand with
technological developments.
GUIDELINES FOR DESIGNING JOBS FEATURING REPETITIVE TASKS I5I
It is necessary for engineers and, above all, supervisors, to organise periodical meetings with workers
in order to gather information on any practical problems emerging in the performance of the various
tasks. Their prompt detection and elimination will prevent unnecessary damage to workers' health, and
often lead to a better product.
Thus the production engineer together with the job analyst are key figures in the training process,
receiving training and insight from expert consultants and providing practical training for the workers.
It is thus the responsibility of the production engineer to"
- suitably design how a task must be performed, above all optimising the technical actions in terms of
human health, and not just productivity;
- teach workers how to perform tasks correctly;
- periodically check that tasks are being performed correctly;
- periodically talk with workers about the possible onset of problems while performing tasks;
- check that technological innovations do not cause increased risk factors;
- attend to new workers and ensure they are given proper training for their tasks, especially complex
ones.
c) Training for management.

Managers need to be involved in the training process, which must be carried out by experts; managers
must be able to provide trainers with a thorough picture of the risk factors present in the work cycle, as
well as possible strategies (manual, organisational, training and occupational health care) which
together ensure that such factors are minimised and effectively managed. This knowledge, in addition
to a clear understanding of their responsibilities, including awareness and liability, will enable managers
to make the best possible decisions for the organisation and management of the production process.
ADDENDUM
Example of how to use the OCRA Index to redesign a workstation
Once the workstation has been analysed using the OCRA index, and checking for the presence of risk
factors for the upper limbs, it is possible to use the same index in order to theoretically detect which
risk factors should be dealt with to minimise the worker's exposure.
Therefore, several versions of the OCRA index are described in which the different risk factors
making up the index are gradually reduced.
The same example used in Chapter 11 can also be used here (sheet 11.8). The OCRA values can be
seen to be high" 6.1 for the right limb and 5.4 for the left limb. The job is comprised of two alternating
tasks (A and B), featuring: high frequency actions (task A = 53.3 actions/minute, task B = 63.7
actions/minute, both involving the right limb.); moderate use of force; high risk hand posture;
inadequate distribution of recovery times (and an almost adequate rest period of 38 minutes, but
concentrated into only two breaks) (Sheet 5.2a, Chapter 5).
Sheets 14.1 and 14.2 in the Addendum describe the final calculation of the OCRA index, already
illustrated in Chapter 11 (Sheets 11.7 and 11.8 respectively).
With reference to the example mentioned above, Sheet 14.3 reduces the action frequency for both
tasks A and B, to 45 actions/minute for the right limb and 35 for the left. The total number of actions
in the shift is reduced to 14472 movements for the fight limb and 11256 for the left.
If the OCRA index is recalculated introducing this one variation, the resulting values drop to 4.9 on
the right and 4.7 on the left (Sheet 14.4).
Sheet 14.5 introduces a reduction in the use of force, bringing it to acceptable levels: the OCRA index
shows 5.5 on the right and 4.4 on the left.
Sheet 14.6 presents a recalculation of the OCRA index in which nothing but the distribution of the
recovery times is optimised, i.e. dividing the available 38 minutes into four 9-10 minute breaks: the
OCRA values drop to 4.5 on the fight and 4 on the left.
Sheet 14.7 optimises two factors simultaneously: use of force and distribution of recovery times.
The OCRA indexes drop to 4.1 on the right and 3.3 on the left.
Sheet 14.8 shows three variables optimised: the previous two, plus a reduction in the action
frequency. The OCRA values drop to 3.3 on the right and 2.9 on the left.
If the objective is to reach the "risk absent" level - the green level - then further modifications have
to be introduced, such as an improvement in hand posture (not always a simple process, especially when
the risk is due to "pinching" grips) and recovery times (with six 7-8 minute breaks, obtained by
increasing the 38 minute resk factor to 42-48 minutes). The OCRA values then drop to 2 on the fight
and 1.9 on the left: values that can be regarded as being in the risk-absent area (the green-yellow area)
in Sheet 14.9. Since it is not possible to increase the recovery times, the action frequency can be reduced
(still at a relatively high 45 actions/minute), or, alternatively, the worker can be rotated on a low-risk
task.
Sheet 14.10 proposes a summary of the OCRA indexes described so far, in which the optimisation of
each individual factor or set of factors is shown.
GUIDELINES FOR DESIGNING JOBS FEATURING REPETITIVE TASKS I53
Sheet 14.1 - An example of calculation of the OCRA index: concise data for the calculation of the total number
of technical actions with repetitive tasks carried out within a cycle (e.g., taken from Chapter 11, sheet 11.7 to
enable successive calculation of the OCRA index)
liB I I
I
Department or line. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ShlfL ..... I ~ an d II ~ ....
Post or task.,, 11) W EL D IN G O F THE R O D B) CUTTING OF TERMINAL HOLE. .............

I
Charactefisation of repetitive tasks within a shift

i
RIGHT ARM LEFT ARM

l i
i
TASKS TASKS
A B C D
9 Duration of task within the "225.2 96.4 Z25.2 96.4
shift (min)
9 Average duration of cycle (see) 9

(n.actions/min)
i
9 Total actions in task 12003 i141 9008 3856
9 total actions in shift Ae 12864 Ae

(sum of A, B, C, D)
Characte.risation of non-repetitive tasks within the shift
TASKS
i
X Y Z
r


as recovery period
N•E•o~176176176176
* O ~ , o * * * o o ~ * o o * ~ * o Q o ~ * o * o r . . . . ~ 1 7 6 1 7 6 1 7 6 1 7 6 1 7 6 1 7 6 1 7 6 1 7 6 1 7 6 1 7 6 1 7 6 1 7 6
~ ~ o ~ o ~ ~ ~
I54 RISK ASSESSMENT AND MANAGEMENT OF REPETITIVE MOVEMENTS AND EXERTIONS OF UPPER LIMBS
Sheet 14.2 - Calculation of OCRA exposure index taken from an example illustrated in Chapter 11, sheet 11.8
RIGHT ARM LEFT ARM

A B C D A B C D 1"==1(/=
9 Action fmquQnqY qonstant (no. of actions/min.) 30 30 30 30 30 30 30 30 C.F.
9 Fgrce factor (perceived effort)
BORG 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 A B C D A B C Tuk/s

FACTOR 1 0.85 0.75 0.65 0.55 0.45 0.35 0.2 0.1 0.01 0.90 0.90 0.80 0.90 Ff
X
9 Postuml factor C D A B C D Taslds
,
SHOULDER 12 8 (*) selectlowestfactor
VALUE 0-3 4-7 8-11 12-15 16 ELBOW 10 8 betweenelbow,wrist
and hand
FACTOR 1 0.70 0.60 0.50 0.33 WRIST 8 10 4 10
HAND 11 12 14 12 Fp
(-) 0.6 0.5 0.5 0.5
x
VALUE 0 4 8 12 A B C D A B C D Task/si
FACTOR 1 0.95 0.90 O.8O 1 1 1 1 Fc
., . . . . . .
X
9 Duration of repetitive task
225 96 225 96
RIGHT LEFT
.k 4941 3996
ng. recommended actions for repetitive
~ k . ~nd in total (Dartial result, without
Recovery factor) (a+13+~*S) ((z+p+'pS)
factor referring to the lack of recovery pedods (no. of hours without adequate recovery)
RIGHT LEFT
Fr = Arp =/Cx Fr A r p = / r x Fr
UuUli u,u/
uuc u u ml I 2964.6 J 2397.6
RKIHT LEFT RIGHT LEFT
Talal no. of ~ ~ In m)~Uve treks 18144 12864

~ all. _ L . . . . _ _- 6.1 5.4
NO..=~m;~,~x. Am 2964 2398
GUIDELINES FOR DESIGNING JOBS FEATURING REPETITIVE TASKS 155
Sheet 14.3- An example of calculation of the OCRA index: induction of frequency

ii iii i i iii
Dcpartmont or ring. .................................................................................... Shift ..... I ~ and II ~ ....
Post or task... A) WELDING OF THE ROD B) CUTTING OF TERMINAL HOLE. . . . . . . . . . . . . .
Character, sat,on of revefitive tasks within a s.hifl
RIGHT ARM LEFT ARM
TASKS TASKS
A [ B C
n
D A B [,c [,D
9 Duration of task within the 225.2 96.4 225.2 96.4
shift (rain)
9 Average duration of cycle (sec) 9 6

(n.actions/min)
9 Total actions in task 12003 S141 9008 3856
9 total actions in shift 12864 Ae
I
Ae
(sum of A, B, C, D)
Character, sat, on of non-repetitive tasks within ~r shi~
TASKS
X Y Z
h f,
Total minutes of task/s that can

i

as recovery period
N•TE•••o•*o•oo*o••••o**•o*o*e*o•••*oo•o••••oIoo•••ooo••e•••••o*o••••o••••o••e**o•••oo•••*o•••o*oo•oeo•••~
~ ~ o ~ ~ 1 7 6 1 7 6 1 7 6
e ~ e o ~ . . o o ~ . ~ * ~ . ~ ~ . . . ~ e ~ o ~ . ~ o ~ . . ~ e ~ . . . ~ . ~ e ~ . ~ o ~
Sheet 14.4 - Recalculation o f OCRA exposure index with redistribution on frequency
RIGHT ARM LEFT ARM
I
9 Action freouency constant (rio. of action~Jmin.) 30 30 30 30 30 30 30 30 C.F.

x
9 Force factor (Derceived effort1
BORG 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 A B C D A B C D TasWs

FACTOR 1 0.85 0.75 0.65 0.55 0.45 0.35 0.2 0.1 0.0i 0.90 0.90 0.80 o.90 Ff
X
9 Postuml factor A B C D A B C D Task/s
SHOULDER 16 e 12 s (') select lowest factor
VALUE 0.3 4-7 8-11 12-15 16 ELBOW 10 8 10 8 between elbow, wrist
and hand
FACTOR 1 0.70 0.60 0.50 0.33 WRIST 8 10 4 10
HAND 11 12 14 12 Fp
(*) o.e 0.5 o.5 o.5
x
* Additional factors
VALUE 0 4 8 12 A B C A B Task/si
FACTOR 1 0.95 0.90 0.80 1 1 1 1 Fc
x
9 Duration of repetitive task A B C D A B D Task/s
225 96 225 96
RIGHT LEFT
1~ /1:
*no. recommended actions for reof~titive 4941 3996
task. and in total (partial result, without

Recovery factor) ((x+p+y*8) (a+l~+pS)
RIGHT LEFT
A r p : / I ; x Fr A p =/I; x Fr
2964.6 2397.6
RIGHT U RIGHT LEFT

Totld no. of ~ s oblenmd in ~ risks
I.E. = . . . . . . . . 4.9 4.7
No. mcomm6m~l a d k ~
G U I D E L I N E S FOR D E S I G N I N G JOBS F E A T U R I N G REPETITIVE TASKS I57
Sheet 14.5- Recalculation of OCRA exposure index with reduction of force
RIGHT ARM IIII

LEFT ARM
i l iilli
D Alei D IT=~
9 Action freouencv constant (no. of ~lr 30 3ol
•
9 Force ~ (_m.=eh~ede f t )
BORG HBamimmimmaIE mQE

FACTOR
EHE Ff
X
9 Postuml factor A B C D A B C D Tuk/=
, . . . .
SHOULDER (*) Nk~t lowestfactor

. . . . .
VALUE 0.3 I 4-7 18-111 12-15 I 18 ELBOW between elbow, wrist

....
and hand
FACTOR WRIST
HAND Fp
=mmm'm~i ~IB
VALUE o 4 8 12 A B D A B C D Tasldsi
FACTOR 1 0.95 0.90 0.80 1 1 1 1

,,
Fc
x
9 Duration of repetitive task A B D A B C D Taslds
225 96 225 96
RIGHT LEFT
nil
no. recommended actions for repetitive 5490 i 4815

Recovery factor) a p y a a p y 8 (,z+p+~) (,z+p+~8)
, factor referring to the lack of recovery periods (no. of hours without adequate recovery)
RIGHT LEFT
NO.HOURS 0 1 2 3 4 5 6 7 o Fr = Arp : R x Fr Arp ,,/1; x Fr
FACTOR 1 0.90 0.80 0.70 0 . 6 0 0 . 4 5 0 . 2 5 0.10 0
3294 2889

Total no. of actions observed in repetitive tasks Ae 18144 12864
I.E. = . . . . . --. ,...
5.5 4.4
No. recommendedactions Am 3294 2889
Sheet 14.6 - Recalculation of OCRA exposure index with redistribution of recovery periods
RIGHT ARM LEFT ARM

A B C D A B C D Tlulk/l
9 A ~ o n freauencv constant (no. of actions/min.~ 30 30 30 30 30 30 30 3O C.F.
i
•
9 Fgrce factor fl)erce~ved effort)
BORG 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 A B C D A B C D Task/s
FACTOR 1 0.85 0.75 0.65 0.55 0.45 0.35 0.2 0.1 0.01 0.90 0.90 0.80 0.90 I=f
x
9 Postuml factor A B C D A B C D Taslds
SHOULDER (') select lowest factor

VALUE 0-3 4-7 8-11 12-15 16 between elbow, wrist
and hand
FACTOR 1 0.70 0 . 6 0 0 . 5 0 0.33 WRIST
HAND Fp
(*) 0.6 0.5 0.5 0.5
,
•
VALUE 0 4 8 12 A B C D A B D Task/si
FACTOR 1 0.95 0.90 0.80 1 1 1 1 Fc
X
9 Duration of repetitive task A B C D A B D Taslds
225 96 225 96
RIGHT LEFT
71; m..mm,mmm
4941 3996
*no. recommended actions for reoetitive
Recovery factor) ; ~ (a+p+y*~) (a+p+y,~)
factor referring to the lack of recovery periods (no. of hours without adequate recovery)
RIGHT LEFT
Fr = A r p : / I ; x Fr Arp =/r x Fr
lma/ , lmlB/a/aa/i
B N B IrT~ I r ~ l ~ ~ Iff~ ~ r1~ E 3953 3197
RIGHT LEFT m~, r LEFT

Total no. of actions obsented in ~ tasks AID 18144 12864
LE. z 4.5
3m 3197
GUIDELINES FOR DESIGNING JOBS FEATURING REPETITIVE TASKS I59
Sheet 14. 7 - Recalculation of OCRA exposure index: optimisation of use of force and distribution of recovery times
RIGHT ARM LEFT ARM i
,,
9 Action freauencv constant (no. of a~'tions/min.~ 30 30 30 30 30 30 30 30 C.F.

,,
x
9 Force factor (oercetved effort)
mlimlmiDgmlm lB
I l/ W mmmmm
C
x
D
1
A
1
B C D TasWs
Ff
9 Postural factor A B C D A B C D Task/s

. . . . .

VALUE 0-3 4-7 8-11 12-15 16 ELBOW between elbow, wrist
and hand
FACTOR 1 0.70 o.8o 0 . 5 0 0.33 WRIST
HAND
Fp
(*) 06 05 0.5 ) 0.5
X
9 .A.ddi.tionalfactors
VALUE 0 4 8 12 A B C D A B D Task/si
FACTOR 1 0.95 0.90 0.80 I 1 1 1
,
Fc
X
9 Duration of repetitive task A B C D A B D Task/s
225 96 225 96
, ,
RIGHT LEFT
/T /I;
no. recommended actions for reoetitive 5490 4815

.tas,k,. and in total (oartial result, withou_t
Recovery factor) (x p 7 ~ (~ 13 u 8 (a+p+~.8)
RIGHT LEFT
NO.HOURS 0 1 f 2 ~ = 4 S e 7 a Fr =
Arp -'/1: x Fr Arp ,=/1: x Fr
~c~o, , o.,o o., o.,o o.,0 o.,, o.,~ O.lO 0 133"-I
, , II I I 4392 3852
RIGIr LEFT RIGHT LEFT

T(~III no. of ~ ~ I e M K I [11~ Ae 18144 12864
I.E.= . . . . = ,,,,
4.1 3.3
No. ~ m l l ~ l ~tto~ Arp ~92 " 3=2
16o RISK ASSESSMENT A N D M A N A G E M E N T OF REPETITIVE M O V E M E N T S A N D EXERTIONS OF U P P E R LIMBS
Sheet 14.8 - Recalculation of OCRA exposure index with three variables optimised: force, recovery times and
action frequency
RIGHT ARM LEFT A R M

Tm
. Action fmauencv constant (no. of actions/min.) C.R
9 Force factor mervelved e f ~
g Ol
=u=u=u=u=u
NmWmmmml l II
=,==--
l i m I i i=I. a n - / v v X
i
Postural factor A B C D A B C D Ten,J=

,
SHOULDER (') select lowestfactor

VALUE 0-3 4-7 8-11 12-15 16 ELBOW between elbow,wrist
and hand
FACTOR 1 o.7o 0.60 0.50 0.33 WRIST
HAND Fp
(*) 0.6 0.5 0.5 0.5
X
9 Additoinal factors
VALUE 0 4 8 12 A B C A B Task/si
FACTOR 1 0.95 0.90 0.80 1 1 1 1 FC
_
9 Duration of repetitive task A B C D A B Task/s
225 96 225 96
RIGHT LEFT
/1;
r a m , m , , ,
11:
no. recommend~l ~ct;ions for repetitive 5490 4815
Recovery factor) a p 7 ~ a 13 7 ((x+p+~8)
factor refardng to the lack of recovery periods (no. of hours without adequate recovery)
RIGHT LEFT
A r p = / l : x Fr Arp =/1: x Fr
UWl l Wmul u xnm 4392 3852
RIGHT LEFT
Total no. of Ictio~ oi=wn~l In ~ ~ AG 1~~~ ~ . ~
I~..- 3.3 2.9
m. recommendedactions ~ 4392 3852
G U I D E L I N E S FOR DESIGNING JOBS FEATURING REPETITIVE TASKS 161
Sheet 14.9 - Recalculation o f OCRA exposure index: how to reach the green level improving hand and posture
optimising the recovery times
. .
RIGHT
. . . . .
ARM
. .
LEFT ARM
A B C D A B C D TesWs
9 Action freauencv constant (no. of agti0ns/min.) 30 30 30 30 30 30 30 30 C.F.

X
9 Force factor (DercQived eff,O~)
BORG
|UNUlUIB (A ~ f B "~ C D A' B " C "D Task/s
FACTOR Ff
•
, H
9 P_ostumlfactor A B C D A B C D Task/s
SHOULDER (*) select lowestfactor
VALUE 0-:3 4-7 8-11 12-15 16 ELBOW between elbow, wrist
,,
and hand
FACTOR 1 0.70 0.60 0.50 0.33 WRIST
HAND i
(*)'~r 0.7 S
~f~ 0.7j
Fp
X
VALUE o I 4 8 12 A B C D A B C D Task/si
I
FACTOR 1 0.95 0.90 0.80 1 1 _ 1 1 - Fc

L ~ , . . . . .
x
_
9 Duration of repetitive task _

A B C D A B C D TaskJs
, , ,
225 96 225 96
,,,
-- RIGHT LEFT
/[ 11:
no. recommended actions for repetitive i 6741 I 6741
i
Recovery factor) P 7 ~ ,z 13 y 8 (~§ (=,p+y,~)
~=~_ ~ . . . . . _i i
RIGHT LEFT
NO'HOURSI c)~l 1 1 2 I 3 I 4 I 5 1'6 I 7 I 8 ~ Fr Fr : Arp :/1: x Fr Arp : / I ; x Fr
F'CTOR |1 J10"0010"0[0"70[0" 0['0"S10"2510'10101 | 6741 6741
V . . . . .
RIGHT LEFT
Total no. of actions obsonoor in repetitivetasks Ae ~ 1 4 4 7 2 j ~19956 j
I.E. : . . . . . : , : 2.1 1.8
No. recommended=orion= Arp 6741 ' 6741
I62 RISK ASSESSMENT A N D M A N A G E M E N T OF REPETITIVE MOVEMENTS A N D EXERTIONS OF UPPER LIMBS
00
9 o
N i,-
oz
in an
E E
l-
(,O
u o c~ an d d O O O O
>
0
0
in U.l
Iz:
,u U.l
,a. {.l:) t . ' ) q u4') (tD, L t ) I 14') n4~

o
o
o
o
oo
0 9 .
dc~ d d o d d ~n~- ~i o
o
~
0 oo9 oom GO
~ ~,-,-1,- ,-I,- ~{~ .
d~l'-'-l'- 9
1--
14=
Z
U')
~I ~ J~
~ ~o
z
0
.m "-
I-
,<
I::
I- ! I
< ml< ml< ml< <m<m <m ml< ml< ml< m

-I
r~
15. A LONGITUDINAL STUDY OF WORKERS WITH WMSDS
AFTER RETURNING TO A REDESIGNED WORKSTATION:
CRITERIA FOR THE RETURN OF WORKERS TO THE W O R K F O R C E
Introduction
The relocation of workers suffering from work-related musculo-skeletal diseases (WMSDs) is one of
the major practical problems in work situations where several different tasks may be involved in causing
a potential biomechanical overload of the upper limbs. Subjects with such diseases, which are identified
in the course of health surveillance programmes, are also judged temporarily or permanently "unfit" to
perform tasks that are likely to have caused or negatively influenced the evolution of the disease. The
aim of this chapter is to summarize a practical experiment in the relocation of a group of subjects with
disorders due to mechanical overload of the upper limbs, with a description of the trend of the disorders
and diseases observed by means of a longitudinal study carried out over a period of five years.
The chapter explains the criteria, procedures and practical solutions adopted in order to relocate these
subjects with reduced fitness to tasks and jobs with "less" exposure. In this way it was possible to
maintain the workers in a sufficiently productive type of work and at the same time guarantee adequate
protection of their health.
The practical experiment referred to was carried out in a major metal-working plant (Embraco srl),
in particular on the assembly lines of motors for refrigerating equipment. At present the plant employs
1851 people in production departments, 1468 of whom perform repetitive tasks. Since 1995 the
company has been operating programmes for the prevention of risks due to biomechanical overload of
the upper limbs; in 1995 a specific programme of risk assessment and health surveillance was
undertaken, that was initially restricted to the departments with greater risk but which was more recently
extended to practically all production departments.
The highest exposure values were observed in the Electric Motors department (Mean OCRA = 5.8);
mean values on the other assembly lines varied from 3.4 to 3.9 (Colombini et al., 1998).
The redesign of tasks
In order to ensure that the programme would be effective and enduring, the authors opted for an
intensely participatory approach. Both the technical staff (at the management, shop floor and
supervisory level), the affected workers and the plant medical staff were involved.
The technical staff were trained to submit the relevant jobs to the specific risk assessment procedure,
so as to more effectively re-design tasks for both "healthy" and diseased workers.
A special course was conducted by skilled consultants covering the following subjects:
- definition of WMSDs of the upper limbs and their relationship to work conditions;
I64 RISK ASSESSMENT A N D M A N A G E M E N T OF REPETITIVE MOVEMENTS AND EXERTIONS OF UPPER LIMBS
- introduction to the pathogenesis of the principal upper limb disorders related to repetitive movements;
- methods and criteria for rating occupational risk: techniques for measuring frequency by analysing
slow-motion films, methods of applying an upper limb strain index using the Borg Scale, criteria for
detecting awkward postures and evaluating recovery times, identification and measurement of
additional risk factors.
Once the technical staff were adequately trained, they were asked to inspect their respective
departments and to single out jobs and tasks that would be immediately suitable for WMSD-affected
workers, or could be adapted with minimal changes. The decision-making criteria and requirements
were defined during the course of the training programme.
When tasks were not entirely suitable for WMSD-affected workers, according to the relevant criteria,
job design recommendations were drafted.
Jobs or tasks needing to be re-designed were analyzed with the factory's engineering staff, who
studied the technical and economic feasibility and speed of implementation of the required
modifications.
The recommendations for re-designing tasks for WMSD-affected workers were based on the
following criteria:
- frequency: less than 20 actions/minute;

- minimal upper limb exertion (less than 5% of the MCV, or a score of 0.5 on the Borg scale);
- posture and movements not requiring "intense involvement" of the main joints;
- adequate recovery periods during each shift (Colombini et al., 1998).
If posture was not optimal, the recommendation was to slow down the frequency of the actions, with
special attention being devoted to the clinical findings of the worker involved.
If the task involved the occasional handling of loads (which WMSD-affected workers may be allowed
to do under certain conditions) the following weights were considered when the handling operations
were carried out with the correct posture:
- the lifting of loads weighing more than 15 kg was altogether avoided;

- the occasional 14-15 kg load, if lifted by 2 workers no more than once every 60 minutes;
- the occasional 7-10 kg load, if lifted by 2 workers no more than once every 30 minutes;
4-5 kg loads, no more than 2-3 times every 30 minutes, if lifted alone.
-
In order to facilitate communications between the technical staff and the medical staff within the
factory, the results of the analysis of the various jobs and tasks were classified, as was the
degree/severity of the WMSDs detected. It was thus possible to more easily match the WMSD-affected
workers with the most appropriate tasks.
The following ratings were developed:
Task:
- GOOD with modifications (suitable for workers with moderately severe WMSDs, provided the
recommended modifications are adopted).
- EXCELLENT with some limitations (no modifications needed, but not suited to all WMSD-affected
workers).
- EXCELLENT with no limitations (no modifications needed; suitable for all WMSD-affected
workers).
A LONGITUDINAL STUDY OF WORKERS WITH WMSDS AFTER RETURNING TO A REDESIGNED WORKSTATION I6 5
Disease degree:
- SLIGHT: only one part of the upper limb affected slightly.
- MODERATE: only one part of the upper limb affected moderately, or several parts affected slightly.
- SEVERE: only one part of the upper limb affected severely, or several parts affected moderately.
Timetable for returning WMSD-affected workers to the workforce
The principal aim of reassigning workers with WMSDs of the upper limbs to new or re-designed jobs
or tasks was to alleviate the clinical signs and symptoms associated with the disorder, while maintaining
the worker's productivity.
As the criteria for selecting and re-designing jobs were highly experimental, close co-operation
between the technical staff, the plant medical staff and, above all, the workers themselves was essential,
in order to ensure that the results of the various decisions implemented could be monitored continuously.
Workers known to have work-related disorders have to be interviewed by medical staff regarding
their symptoms upon starting the re-designed job. The interview can be carried out using a closed-ended
clinical questionnaire (Colombini et al., 1998).
Meetings can be arranged between the consulting physicians and the workers involved in the study.
The meetings have to be designed to make the workers more aware of how best to co-operate with the
medical and technical staff in verifying how successfully the jobs are re-designed and allocated.
During the meetings (for groups of max. 10 workers), the following points have to be discussed:
- type and pathogenesis of the most common WMSDs of the upper limbs; reasons for changing and
shifting workers to new or re-designed tasks and jobs;
- need to pay careful attention to any disorders affecting the upper limbs, and in particular to any flare-
up of existing symptoms (if symptoms worsened, the worker was invited to notify the plant physician,
even between regularly scheduled follow-up appointments);
- need to pay careful attention to the new method adopted for performing the task, and inform the
supervisor whenever any unforeseen problems arise (e.g. use of excessive force, inability to keep up
with required speeds, etc.); correct "use" of the modified job, and in particular: correct use of the
recovery times, importance of maintaining a regular pace without accelerating the frequency of the
actions, importance of avoiding the needless lifting of harmfully heavy loads.
Health care monitoring: cases and methods of diseases classification
Given that the criteria for re-designing jobs and tasks for WMSDs-affected workers were purely
experimental, it is essential to closely monitor developments almost continuously, so that any specific
technical and organizational modifications can be made promptly.
In order to validate the decisions made in relation to the various diseases present, a special health care
programme was embarked upon which aimed to m o n i t o r - at very close intervals - the medical
condition of the workers in their newly designed jobs, as well as their "degree of acceptance" of the
jobs. A simple questionnaire can be used to monitor the workers (Annex 1), designed specially to obtain
information regarding"
- changes in muscolo-skeletal disease (classified as" symptoms completely disappeared, symptoms

improved, situation unchanged, symptoms worse, appearance of new symptoms or disorders);
Annex 1
QUESTIONNAIRE FOR WORKERS

WITH WORK RELATED MUSCULOSKELETAL DISORDERS (WMSDs)
i
Day M o n t h Yem
DATE OF EXAMINATION: I J J LIJ LIJ DATAV
NAME and SURNAME I j _ L I j j j j j j j j j j j j j j j j j j j j j _ L L I j _ L I I I

DW ~ Y~r
DATE OF BIRTH: I _ l g I I._1 I._1__1 DATA SEX M-I F-= L I sex
CURRENT DEPARTMENT: IJ_LLLLIJJJJJ .~A EMPLOYEE REF. No. I_.1__1._1. I__1_.1

CURRENT LINE (OR OTHER WORKSTATION) I.._1....1_.1.._1...1__.1 I.INr~
[ 1 ] PERFORMS RE-DESIGNED JOB (approx. 20 actiona/minute) OR ALREADY OPTIMAL JOB i__l

[ 2 ] PERFORMS NON RE-DESIGNED JOB RIPRO
IF PERFORMING RE-DESIGNED OR OPTIMAL JOB: HOW LONG IN THIS JOB? ijgj

RIPROME
CURIRENT EXAMINATION
[1] ............................ [2] ............................ [3] I__1

CONTRO
UPPER EXTREMITY SYMPTOMS REPORTED BY WORKER RELATIVE TO LAST 6 MONTHS
LEFT SHOULDER RIGHT SHOULDER
[ 0 ] WAS ALREADY NEGATIVE AND STILL IS [ 0 ] WAS ALREADY NEGATIVE AND STILL IS
IF PREVIOUSLY POSITIVE: IF PREVIOUSLY POSITIVE: I I
[ 1 ] SYMPTOMS COMPLETELY DISAPPEARED [ 1 ] SYMPTOMS COMPLETELY DISAPPEARED SPALLAD
[ 2 ] SYMPTOMS IMPROVED [ 2 ] SYMPTOMS IMPROVED
[ 3 ] SITUATION UNCHANGED BY PREV. IMPROVEMENT [ 3 ] SITUATION UNCHANGED BY PREV. IMPROVEMENT
[ 4 ] SITUATION UNCHANGED BY PREV. WORSENING [ 4 ] SITUATION UNCHANGED BY PREV. WORSENING ij
[ 5 ] SYMPTOMS WORSENED [ 5 ] SYMPTOMS WORSENED SPALLAS
[ 6 ] ONSET OF NEW SYMPTOMS IN PREVIOUSLY [ 6 ] ONSET OF NEW SYMPTOMS IN PREVIOUSLY
ASYMPTOMATIC SUBJECT, WITH FOLLOWING ASYMPTOMATIC SUBJECT, WITH FOLLOWING
CHARACTERISTICS: CHARACTERISTICS:
[ ] PAIN ON MOVEMENT VIRTUALLY CONTINUOUS [ ] PAIN ON MOVEMENT VIRTUALLY CONTINUOUS
[ ] SEVERAL EPISODES (AT LEAST 5) [ ] SEVERAL EPISODES (AT LEAST 5)
[ ] ONLY 1 PAINFUL EPISODE LASTING AT [ ] ONLY 1 PAINFUL EPISODE LASTING AT
LEAST 2 WEEKS LEAST 2 WEEKS
COMMENTS: ..............................................................................................................................................................................
LEFT ELBOW RIGHT ELBOW
[ 0 ] WAS ALREADY NEGATIVE AND STIU. IS [ 0 ] WAS ALREADY NEGATIVE AND STILL IS

[ 1 ] SYMPTOMS COMPLETELY DISAPPEARED [ 1 ] SYMPTOMS COMPLETELY DISAPPEARED GOMID
[ 4 ] SITUATION UNCHANGED BY PREV. WORSENING [ 4 ] SITUATION UNCHANGED BY PREV. WORSENING I I
[ 5 ] SYMPTOMS WORSENED [ 5 ] SYMPTOMS WORSENED GOMIS
COMMENTS: ..............................................................................................................................................................................
A LONGITUDINAL STUDY OF WORKERS WITH WMSDS AFTER RETURNING TO A REDESIGNED WORKSTATION 167
Annex 1 - Continued
...... ,
LEFT HAND/WRIST/FINGERS RIGHT HANDNVRIST/FINGERS

IF PREVIOUSLY POSITIVE: IF PREVIOUSLY POSITIVE:
[ 1] SYMPTOMS COMPLETELY DISAPPEARED [ 1] SYMPTOMS COMPLETELY DISAPPEARED
[2] SYMPTOMS IMPROVED [2] SYMPTOMS IMPROVED
[3] SITUATION UNCHANGED BY PREV. IMPROVEMENT [3] SITUATION UNCHANGED BY PREV. IMPROVEMENT
[4] SITUATION UNCHANGED BY PREV. WORSENING [4] SITUATION UNCHANGED BY PREV. WORSENING I_._1
[5] SYMPTOMS WORSENED [5] SYMPTOMS WORSENED POLSOO
[6] ONSET OF NEW SYMPTOMS IN PREVIOUSLY [6] ONSET OF NEW' SYMPTOMS IN PREVIOUSLY
[ ] NOCTURNAL PARAESTHESIA AND/OR PAIN I__1
[ ] NOCTURNAL PARAESTHESIA AND/OR PAIN POLSOS
(during daytime rest in shift worker) (dudng daytime rest in shift worker)
(continuous or sub-continuous; at least one episode (continuous or sub-continuous; at least one episode
per week over the last 3 months) per week over the last 3 months)
[ ] CONTINUOUS OR SUB CONTINUOUS DIURNAL [ ] CONTINUOUS OR SUB CONTINUOUS DIURNAL
PAIN (at least 5 episodes in the last 6 months) PAIN (at least 5 episodes in the last 6 months)
LOCATION: [ ] WRIST LOCATION: [ ] WRIST
[ ] FIRST DIGIT [ ] FIRST DIGIT
[ ] OTHER [ ] OTHER
. . . . . . .
COMMENTS: .................................................................... EMPLOYEE'S SIGNATURE:
i i i ii iii
9 i el ill
DIAGNOSTIC LINK
KIND OF PATHOLOGY: DIAGNOSIS:
i-i .... L i ~ .........................................................................................................................................................
i-i .... i~EDl~ii ..................................................................................................................................................... ,_,_aj

ARUNO
,-i .... i ~ .......................................................................................................................................................

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I. . . . I. I I
ARDUE
I._L_LI
/U~TRE
I I I I
~QUA
p__l__lj
i i_j i
ARSEI
SUMMARY SYM PTOM-NEGATIVE [ 1] SHOULDER
[2] ELBOW
[4] WRISTS/HANDS/FINGERS
[8] POSITIVE FOR ALL JOINTS
I I I I
[0] ALL JOINTS NEGA
REFERRALS REQUIRED:
[0]NO [11 YES

I I
[ ] PHYSIOTHERAPY ] ...................................... V~A
[ ] NEUROLOGICAL
[ ] X-RAY
[ ] EMG
Annex I - Continued
ASSESSMENT OF WORKER'S CURRENT DUTIES:
The worker's current job is at risk of:
- awkward posture of the [ ] shoulder JR] [L]

[ ] elbow [R] ILl
[ l wrist JR] ILl
- excessive force on upper Hmb [R] [L]
- force and discomfort when Htting containers [ ] YES
[ ]NO
OPERATIONAL LINK FOR TECHNICAL PERSONNEL
[ 0 0 ] EXCLUDE FROM WMSDs GROUP UNDERGOING HEALTH SURVEILLANCE
[ 1 0 ] CAN REMAIN IN NON RE-DESIGNED JOB (PRESENT WORK STATION)

i._1._.1
OPERA
[ 2 0 ] MUST REMAIN IN RE-DESIGNED JOB (OR OPTIMAL JOB FOR WMSDs)
[ 3 0 ] MUST BE TRANSFERRED TO RE-DESIGNED JOB FOR WRIST AND ELBOW
[ 3 1 ] MUST BE TRANSFERRED TO RE-DESIGNED JOB FOR SHOULDER
[ 3 2 ] MUST BE TRANSFERRED TO RE-DESIGNED JOB FOR WHOLE UPPER LIMB
[ 4 0 ] REVIEW WORK-STATION, EVEN IF RE-DESIGNED, FOR WRIST/ELBOW AREA
[ 41 ] REVIEW WORK-STATION, EVEN IF RE-DESIGNED, FOR SHOULDER AREA
[ 4 2 ] REVIEWWORK-STATION, EVEN IF RE-DESIGNED, FOR WHOLE UPPER LIMB
[ 5 0 ] MODIFIED WORK-STATION BUT NOT FOR WMSDs
I I USE A WORK-STATION WITHOUT MANUAL MATERIAL HANDLING I_.1 SPINE
- assessment of acceptability of new job/task, with details concerning any inadequacies deriving from:
awkward postures, excessive muscle force, etc.
Moreover, the questionnaire aimed to provide a diagnostic link, for possibly requesting further
clinical or instrumental tests and a useful operational link for the production engineers. Based on the
results of the study, the physician was able to provide the engineering staff with practical information,
which may be summarized as follows:
A LONGITUDINAL STUDY OF WORKERS WITH WMSDS AFTER RETURNING TO A REDESIGNED WORKSTATION I69
- the worker must be transferred to a re-designed work station (new case or worsening of anamnestic case);
- the worker must remain in his/her current work station re-designed for "WMSD-affected" workers
(clinical case);
- the worker may continue to perform his/her duties in the current job, even if not re-designed for
"WMSD-affected" workers (anamnestic case);
- the worker need no longer be classed as "WMSD-affected" (remission of disease).
This particular monitoring programme can be scheduled as follows"
- check-up two weeks after changing jobs: this helped to roughly assess whether the situation is
satisfactory, and to reinforce the instructions given to the worker;
- check-up three months after changing jobs;
- check-up six months after the previous one;
- check-ups every 12 months thereafter.
The health surveillance programmes carried out at the Embraco plant since 1995 covered both
subjects with known WMSDs and workers employed on repetitive tasks.
Diagnosis of disease was made after examination of the subject at the company medical unit and
further examination and instrument tests (ultrasonography, EMG) at specialised centres. Cases for
which both physical examination and instrument tests were positive were considered to have a WMSD.
Usually, the subjects defined as "severe" were transferred to workstations that had been completely
redesigned, the "average" cases to workstations where risk was at least reduced. Most of the cases
defined as "slight" stayed at non-redesigned workstations but under close health surveillance.
The WMSD subjects were also classified as recovered, improved, unchanged or worsened, according
to the evolution of their health status during the longitudinal study.
Regarding the evolution of the disease, improvement or recovery was declared when the instrument
tests showed improvement or gave negative results. If more than one disease was present in more than
one region, an improvement was declared when the number of regions involved decreased (or a
worsening in the opposite case). Regarding the evolution of symptoms, a subject was considered to have
"improved" when, during the longitudinal study, the disorder involving one or more joints mostly
tended to improve (or worsened in the opposite case), and to remain "unchanged" if the disorders were
stable. In order to better classify improvement (or worsening) a distinction was made between subjects
who remained unchanged after an initial improvement (unchanged from improved ) or after an initial
worsening (unchanged from worsening), the first counting as improvement and the second as
worsening.
Preliminary results of the health care monitoring p r o g r a m m e
These are the preliminary results of the health care monitoring programme undertaken on workers
affected by WMSDs who were transferred to a re-designed job or task one year earlier.
The type of disease affecting the 92 workers before they were returned to the workforce is indicated
in Figures 15.1, 15.2 and 15.3: on the whole, carpal tunnel syndrome, from initial to severe is the most
frequent (72%), while a smaller number of wrist/hand tendonitis (13%) was observed. Scapulo-humeral
periarthritis and epicondylitis appeared with the same frequency (28% and 23%, respectively). Carpal
tunnel syndrome was found more frequently among the females (88%) than males (45%). Epicondylitis
was found more frequently among the males (males 43%, females 10%). Figure 15.2 indicates that the
170 RISK ASSESSMENT A N D M A N A G E M E N T OF REPETITIVE M O V E M E N T S A N D EXERTIONS OF U P P E R LIMBS
Figure 15.1 - Types of WMSDs (TOTAL CASES: 35females males, 57females)
Figure 15.2 - Distribution of disorders by joint and side
various joint disorders were frequently bilateral and Figure 15.3 indicates the presence of disorders
affecting one or more joints.
Since the prevalence of shoulder and elbow disorders was low, the statistical analysis of the relative
complaints was not significant.
The trend for disorders affecting both wrists was analyzed in two different departments (assembly
bay/workshop and electrical engines department).
Figure 15.3 - Distribution o f disorders affecting one or more joints
It was decided to study the two departments separately because the jobs in one department had been
re-designed earlier than in the other due to technical problems associated with introducing the various
modifications, so that a large proportion of the workers in the second department were still performing
jobs that had only been partially re-designed.
Table 15.1 clearly emphasises the difference between the wrist symptoms in the two departments.
In the assembly bay/workshop, 33% of the workers reported that their wrist symptoms (fight hand)
had completely disappeared, and 26.6% reported a distinct improvement: 59.9% of workers reported
improvements, while 33% reported no change in their symptoms and 6% reported a worsening of their
condition.
In the electrical engines department, 33% reported an improvement (complete disappearance of
symptoms + improvements), 39% reported no change, and 28% reported a worsening.
The difference between the two departments is obvious: highly positive results in the first area, with
an almost exponential trend from worse to better while the data are evenly distributed, in terms of
prevalence, among the different possible responses in the second area.
Although the results still need to be more thoroughly analyzed statistically, the positive effects
produced by re-designing the job are unquestionable.
In order to further test the preliminary results, only the subjects with carpal tunnel syndrome in the
two departments were analyzed.
The workers performing re-designed tasks were analyzed separately from those who were still
awaiting a newly designed job, regardless of whether they were working in the assembly bay/workshop
or electrical engines department (63 eligible cases).
The results of the relative analysis are shown in Table 15.2. The gradual improvement in the disorders
reported by the workers performing re-designed jobs is even more striking: the few workers who
complained of a worsening of their complaints were above all those whose jobs had not yet been re-
designed (Table 15.2).
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o
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A LONGITUDINAL STUDY OF WORKERS WITH WMSDS AFTER RETURNING TO A REDESIGNED WORKSTATION 173
t--,~
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In this area, 50% of workers reported an improvement (in the right upper limb), 20% reported no
change and 10% reported a worsening of their condition. The pattern is comparable for the workers with
left carpal tunnel syndrome. Conversely, in view of the situation outlined above, the disorders reported
by the workers in the electrical engines department displayed a considerably less encouraging trend.
Results of longitudinal study of WMSD subjects at redesigned and non-redesigned workstations
In the 5 year longitudinal study on WMSD subjects, 234 subjects were examined and included in the
group: (116 males (49.5%) and 119 females (50.8%). The mean age was 48.9 years (sd 6.9) for the
females and 46.2 (sd 11.6) for the males. In this period a certain amount of turnover was observed, with
new entries every year (about 9%) as well as exits due to recovery (6.4%) or retirement (11%). Presence
in the group was constant in 74% of the cases. The disorders at entry were Carpal Tunnel Syndrome in
26%; tendon disorders involving a single region (shoulder 15%; elbow 11%; hand-wrist 14.7%) in 37%;
mixed tendon and carpal tunnel disorders in the remaining 32.7%. 58% had only one disorder, 27% had
two, 10% had three and the remaining 4.3% had more than 3 disorders.
Table 15.3 reports for each year and in each department the number of subjects in whom WMSD of the
upper limbs was diagnosed. These data cover, cumulatively, the results of successive health surveillance
programmes. Many of these workers continued working in the departments where they contracted the
disease, either at the same workstation or at redesigned workstations. Others were transferred to
departments where all the workstations were already suitable for workers suffering from the said disorders.
Table 15.4 shows the distribution of disorders according to severity, at the beginning and at the end
of the follow-up, and at redesigned and non-redesigned workstations. Overall, the partially redesigned
workplaces increased from 44.2% to 54.7%: subjects with slight or average disorders utilised the
redesigned workstations less than the subjects with severe disorders.
Table 15.5a shows the trend of diseases in terms of "recovery", "improvement", "worsening", or
"unchanged", which was ascertained for each subject between the beginning and the end of the follow-
up. Trends were differentiated between subjects working at non-redesigned (or only recently
redesigned) workstations and those at redesigned workstations. The "slight" cases were by far more
numerous at non-redesigned workstations (66%), the "average" cases were still quite numerous at the
non-redesigned workstations (58%) and the "severe" cases worked only at redesigned workstations
(79.3%). It should be remembered that the "severe" cases were assigned to totally redesigned
workstations and that the "average" and "slight" cases worked at workstations that had only been
partially redesigned. From Table 15.5 it can be seen that the "severe" cases showed higher levels of
improvement (34.7%) and of no change (43.4%). The "average" cases showed improvement in 17.8%
and no change in 46%, which was similar in both partially redesigned and non-redesigned workstations.
A logistic analysis was applied to complete the elaboration of the preliminary results.
In this kind of study the relationship between the severity of the disorders and their evolution after
relocation to redesigned work stations was evaluated. To simplify this analysis a subject was considered
to have improved also when the disease remained unchanged" the case was considered in the study only
when the pathology remained unchanged.
The result of this statistical analysis shows that redesigning jobs has a strong correlation with the
course of WMSDs: nevertheless this needs to be investigated in greater depth.
The ODDs Ratio for non-redesigned workstations shows a positive trend when the severity of the
pathology increases (or = 10.27; 1.96; 0.73).
Nevertheless it is difficult to interpret the different performance of the ODDs Ratio when the
pathology is slight probably due to the presence of confounding factors (workstations partially
A L O N G I T U D I N A L STUDY OF WORKERS W I T H WMSDS AFTER RETURNING TO A REDESIGNED WORKSTATION 175
Table 15.3 - Distribution of subjects with WMSDs by department during the longitudinal study
Dept. 1995
,l
1996 1997 199~1 |
1999
N % N % N % N %
Workshop 27 5.9 30 6.3 27 5.4 23 5.5 49 13.6
Assembl~ 41 6.3 54 8.1 67 9.7 68 8.3 61 817
Electric 33 20.6 39 23.9 57 26.1 41 20.7 32 i4.7
engines
EM 0 0 ,,
5 10.4 8 4.5 13 6.3 11 5.3
Cleaning 0 2,,
2 ,, 3 2
SK 0 0 0 0
0 907
0 0 13
!TOTALS 101 7.4 ,,,
130 9.1 161 138 8.1 168 11.4
Table 15.4 - Distribution of WMSD cases according to severity, at redesigned and non-redesigned workstations
at beginning and end of follow-up
NON- RE-DESIGNED TOTALS

REDESIGNED
,, ,
N % N % N %
Severity at end of SLIGHT 24 i6.2 19 12.8 43 29
follow-up (tot. 148) AVERAGE 18 12.2 36 , ,
24.3 54 36
45% at non- SEVERE 12 8.1 25 16.8 37 25
redesigned
54.7% at redesigned NEGATIVE 13 8.7 1 0.6 14 9.3
Severity at start of SLIGHT 72 34.6 37 ,,L
17.7 109 52
follow-up (tot. 208) AVERAGE 34 16.3 36 17.3 70 34
55.7% at non- SEVERE 6 2.8 19 9.1 25 i2
redesigned
44.2% at redesigned NEGATIVE 4. . . . . . . .
1.9 4 1.9
redesigned at different levels, different kind, gravity and area of pathologies ecc.) : these factors need
further examination.
Table 15.5b uses the same organization of data for the trend of symptoms. The "average" and
especially the "severe" cases showed good levels of improvement (in 57.5% and 61.9% respectively).
"Slight" cases showed a constant trend at non-redesigned workstations (20-30%), whereas cases of
"improvement" and "worsening" at partially redesigned workstations were equally distributed (43.5%
and 47.8% respectively).
On the whole, a tendency to improvement was seen especially in cases of paresthesia: comparing the
evolution of symptoms in the last 5 years of follow-up it was seen that paresthesia improved in 34%,
wrist pain in 16%, elbow pain in 8.3% and shoulder pain in 14%.
Also in this study a case was considered only when the course of the symptoms was costant.
Chi-square tables were prepared in which the columns represent the redesigned work-stations
(yes/no) and the rows the course of symptoms (improved, unchanged, worsened). The fight upper limb
only was analyzed.
9 ~ ~ r-: oq
~o
,, ~.,~ . ,,
~ Z ~ ~ ~ ~ ~ Z O - ~ OO
~~~.~ o ~ ~ 9
.~] . . . . tl) , ,.
ID
~Z ~ m ,.Z "*r"
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"~ Z t-. m o "~Z-o o

Z
DN
~~ ~ ~ -
o Z ~ - eq o Zo, t'- -
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A L O N G I T U D I N A L STUDY OF WORKERS W I T H WMSDS AFTER RETURNING TO A REDESIGNED WORKSTATION 177
The results show non-causal distributions: for the shoulder and wrist pain and parasthesia the "p"
values are less then 0.005, while for elbow pain the "p" values are equal to 0.025.
The results of this descriptive analysis confirm the relationship between the course of symptoms and
the use of a redesigned work-station but in this case further studies are needed considering the different
levels of a redesigned workstation (risk index) and the different kind, area and gravity of the disorders.
D i s c u s s i o n
From this preliminary experience, which might guide further applications, the following can be
concluded:
- it seems essential to reduce the amount of exposure to repetitive tasks of the upper limbs among
workers with such disorders;
- reducing exposure to risk factors associated with repetitive tasks of the upper limbs would seem to
be a sufficiently adequate measure: in fact, this produces a distinct improvement in symptoms;
- the decision to allow workers to perform tasks with a frequency of less than 20 actions per minute,
in the absence of any other risk factors, proves to be a "good starting hypothesis", which deserves
to be further verified and, eventually, validated. This approach moreover preserves the WMSD-
affected worker's residual "productivity";
- for the programme to be successful, it is vital to ensure active participation and excellent
communications between all those involved (technical staff, plant medical staff, workers).
In longitudinal studies of workers with WMSDs, many variables exist for checking the efficacy of
relocation to redesigned workstations. In our study, there were, on the one hand, a set of disorders that
differed in severity (slight, average, severe), region (hand, elbow, shoulder), and type of disorder
(tendon disorders, tunnel syndromes), and on the other hand, there were completely redesigned
workstations (20 movements per minute, zero force, congruent posture, etc.) or workstations that had
been partially redesigned at various levels. We knew, however, that "severely affected" subjects were
assigned to completely redesigned workstations. Age, work seniority and gender may also constitute
other confounding factors. In spite of these problems, it is evident that if subjects with severe disorders
are assigned to completely redesigned workstations the disorders tend to improve, in a significant
percentage of cases, and so do the diseases (although in obviously lower percentages).
Subjects with mild disorders, on the contrary, show a tendency to worsen, independently of whether
they are assigned to non-redesigned or partially redesigned workstations. This confirms the need for a
minimum threshold of workstation redesign requirements for the "mild" cases similar to that initially
used only for "severe" cases.
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ADDENDUM: FORMS AND CHECKLISTS
Checklist

FOR OPERATOR/S:
NAME/S ................................................................................................................................................
PERIOD ................................................. OPERATION ...........................................................................
9 Duration of shift/s I-1 1st shift from ......... ; to . . . . . . . . . ; minutes . . . . . . . . .
F-I 2 nd shift from . . . . . . . . . ; to . . . . . . . . . ; minutes . . . . . . . . .
r-] 3 rd shift from ......... ; to ......... ; minutes . . . . . . . . .
i-] single shift from ......... ; to ......... ; minutes . . . . . . . . .
Physiological factors and rest factors I--I physiological factor D minutes (1st shift) . . . . . . . . . . . . . . . . . .
. . . . . . . . .
r--i minutes (2 nd shift) . . . . . . . . . . . . . . . . . .

l-q rest factor (including
physiological recovery) r-] minutes (3 rd shift) . . . . . . . . . . . . . . . . . .
. . . . . . . . .
9 minutes (single shift) . . . . . . . . . . . .
9 Are physiological recoveries and/or rest factors distributed subjectively?
i-i YES [-] NO
If physiological recoveries a n d / o r rest factors are subjectively distributed, indicate their average use.
If the a f o r e m e n t i o n e d factors are distribued on a planned basis, indicate the duration of breaks:
Meal break . . . . . 9 . . . , . . . . . . . e . . . . . . . . . . . . . . . ,,. . . . . . . . , . . . . . . . .,
1 st break ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 . 9 1 7 6 1 4 9 1 7 6 1 4 9 9 1 4 9 1 .4 .9 . . . . . . ,.
. . . . . . . . . . . . . . | . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 nd break . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . ,,, . . . . . . , . . . . . . . 9 . . . . . . . . . . . . . 9 . . . . . . . . . . . . . . . . . . . . . . . i . 9 1 4 9 1 7 6 1 4 9 1 . 7~ 6 . . . . . . . . . . . .
3 rd break . . . . . 9 ~ | . . . . . . . . 9 1 4 9 . ~ . . . . . . .. 9 .9 . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .o 9 . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1 4 9 1 4 9 1 4 9 9 1 4 9 1 4 9 1 4 9 1 4 9 1 4 9
. . . . . . . . . . . 9 | . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I st shift 2 nd shift 3 rd shift . . .

S i n g l e shift
. .
ADDENDUM: FORMS AND CHECKLISTS 185
Checklist

List of operations performed during the shift ( E l l st [ ~ 2 nd 5 ] 3 rd r-] Single shift)
Duration (min)
r-] In cycles A ..............................................................
a ...............................................................
Repetitive work
C .............................................................. net time
min.
D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . .
E ..............................................................
F] Not in cycles X supply
Y prepare
Non repetitive
Z clean
time net time
min.
W transport
J ...............................................................
H ..............................................................
K ..............................................................
r-] WORK THAT 9 Visual inspection

CAN BE
CONSIDERED
AS RECOVERY Waiting times: Passive times with Recovery time
periods of inactivity lasting in excess of r-'IYES r ] NO min. (do not include
recovery time)
from ...... to ......

Physioiogica
I I I I I I I I I I 1st SHIFT factor and/or rest
min. factor
1st hour
(interruption of
least 5
I I I I I I I I I I 2 nd SHIFT consecutive
1st hour minutes)
from ...... to ......
I I I I I I I I I 1 3 rd SHIFT Shift minutes

(total previous
I st hour min. minutes must
duration
I I I I I I I I I I SINGLE DAILY minutes)
1st hour SHIFT
Describe the distribution of the various repetitive and non repetitive tasks, breaks and/or interruptions, meal breaks
Checklist
DESCRIPTION OF PRODUCTION AND NET CYCLE TIMES (EXCLUDING

PHYSIOLOGICAL FACTORS, REST FACTORS AND NON REPETITIVE OPERATIONS)
NAME .................................................. OPERATION ........................................... PERIOD .................................
9 Repetitive operations (in cycles) with the shift (I-'11 st r-] 2 nd !-]3 rd I-1 single shift)
(A) (B) (**) (A/B)
A
Incentives: [-] YES r-! NO

If yes, from 100 to . . . . . . . . . . . . . . . . .
Average efficiency: 1"7 of the individual worker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
[-I of the group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9 Net cycle times considering efficiency level"
[-! of the individual worker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
[-I of the group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Duration Increase or decrease in Cycle time in estimated

Estimated efficiency
| J ,,
(A) individual group

,,
individual group individual group
= m

ADDENDUM: FORMS AND CHECKLISTS 187
A SHORT DESCRIPTION OF THE TASK, OF THE CYCLE,

AND THE IDENTIFICATION OF THE TECHNICAL ACTIONS
9 TASK 9
RIGHT LEFT
o
2.
3.
4.
5 .
6.
r .7.
8.
~9, . . . . . .
10.
11.
12. "
13.
14.
i
15.
16.
r .,
17.
i . . . . .
18.
'i9.
i
20.
21.
'22. '
r . ,
23.
T O T A L T E C H N I C A L A C T I O N S IN T H E C Y C L E
TASK
T H E OR E T I C AL CYCLE TIME (sec) =

CYCLE TIME ACTUALLY OBSERVED (sec) =
NO. ACTIONS PER CYCLE RIGHT =
LEFT =
ACTION FREQUENCY IN THE CYCLE
NO. A C T I O N S / M I N . = NO. A C T I O N S P E R C Y C L E • 60
CYCLE TIME
TASK RIGHT
LEFT
CALCULATION OF THE OCRA INDEX

i
Department or line ....................................................................................... Shift ...........................

Post or task ....................................................................................................................................
I II I I II I I i
Characterisation of repetitive tasks within a shift

Ill
RIGHT ARM LEFT ARM

II
TASKS TASKS
._
A B C D A B C D
I I ,. , I.
9 Duration of task within the

shift (rain)
9 Average duration of cycle (sec)
9 Action frequency
(n.actions/min)
9 Total actions in task
* total actions in shift Ae Ae

(sum of A, B, C, D)
Characterisation of non-repetitive tasks within the shift

I
TASKS
X Y Z
IIII II I

9 Total minutes of non-repetitive

as recovery period
• T E • o e o o o o * * o o e e e o e o o o o o o e e o o o * o e e o * o o o * e * e o o e * o o o o • o * o o o o o o o o e o * o o e o * * o o * o e o o e o o o e e e o o o o o o o o e o o e o t o o o o e e o * I o e o e
e * 0 * e o o o o e e e o o ~ e ~ o o e * o e o o o e e o o o o o o e e ~ e e ~ e o o ~ o e e e o e e e o e o e I e e e ~ o o e e o I o m e o l e e e o e o i I I I I o e e e o o e o ~ e o e ~ o e o ~ o o o o o e o o ~ o o e e o o o e ~
o o ~ e o ~ e I o o ~ o o e ~ o e ~ U ~ o ~ e ~ e e ~ ` e ` ~ o o o * e ~ e o o o * ~ o o ~ e e * o o ~ o ~ o ~ * o o o ~ o ~ e * ~ o ~ e o e * ~ e ~ o ~ *
ADDENDUM" FORMS AND CHECKLISTS I89
S U B J E C T I V E EVALUATION OF P E R C E I V E D E X E R T I O N W I T H B O R G ' S S C A L E
Line: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Shift ............

Operations "
WHICH ACTIONS MAKE YOU EXERT FORCE WITH YOUR HANDS OR ARMS? CAN YOU EXPLAIN THE REASONS?
TASK A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LIST OF ACTIONS SCORE %AGE DUR. ! INDEX REASONS FOR THE

LIMB
REQUIRING EXERTION (*) OVER TIME ! CALCULATED EXERTION OF FORCE
R , L | R L
.... ,
ALL REMAINING TIME RIGHT

ALL REMAINING TIME LEFT
OVER TIME (E)
TASK B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LIMB I LIST OF ACTIONS SCORE 1%AGE DUR. I INDEX i REASONS FOR THE
REQUIRING, EXERTION (*) OVER TIME CALCULATED EXERTION OF FORCE
" R ] L I R ] L ,
I
ALL REMAINING TIME
OVER TIME (E)
0 NOTHING AT ALL
0.5 VERY VERY WEAK (JUST NOTICEABLE) * Average score obtained, when possible, from more
1 WEAK operators carrying out the same task.
2 WEAK (LIGHT)
3 MODERATE
4
5 STRONG
6
7 VERY STRONG
8
9
10 VERY VERY STRONG (ALMOST MAX)
,
TASK 9 DR V1L
Z RISK
9 SCORE IN
E--, CYCLE
9
~Z
<~

1/3, ~ 2/3, ~ 3/3 of cycle time
I I I
[A4] KEEPS ARMS UPLIFFED (not supported) by over 20~ or in extension for at least 50% of cycle time: SHOULDER
E--, EXCURSION OF AT LEAST 60~

Z~
I I
ELBOW
[131] MOVEMENTS INRISKAREAS: ~ 1/3, [ff'] 2/3, ~ 3/3 supination 1
~Ea, THEY OCCUPY: [~l 1/3, [T] 2/3, [6] 3/3 pronation I of cycle time
9 ~] [~]1/3, 2/3, r6] 3/3 flexion
[B2] LACK OF VARIATIONS-
[-.,
Z
I I I
9 WRIST
[C1] MOVEMENTS IN RISK AREAS: ~ 1/3, ~ 2/3, ~ 3/3 R/U deviation }
(OR MAINTENANCE) TAKES UP: 1/3, ~ 2/3, 3/3 extension of cycle time
1/3, ~ 2/3, 3/3 flexion
[D 1] GRIP TIME AND FINGER POSITION

[--
Z [ ] GRIP (3-4CM) [1] 1/3, [2] 2/3, [3] 3/3
[ ] TIGHT GRIP (1,5CM) [2] 1/3, [4] 2/3, [6] 3/3
[ ] PINCH [3] 1/3, [6] 2/3, [9] 3/3
a~ [ ] PALMARGRIP [4] 1/3, [8] 2/3, [12] 3/3
[ ] HOOK GRIP [4] 1/3, [8] 2/3, [12] 3/3 ~ of cycletime I I I
u.~E [ ] DIGITATION [4] 1/3, [8] 2/3, [12] 3/3 GRIP/HAND
9
[ ] .......................... [2] 1/3, [] 2/3, [ ] 3/3
[ ] .......................... [ ] 1/3, [] 2/3, [ ] 3/3
[ ] .......................... [ ] 1/3, [] 2/3, [ ] 3/3
LACK OF VARIATION: "~
Z finger for at least 50% of cycle time: IX]
<
[D3] keep an object continually for at least 50% of cycle time: 1~
ADDENDUM: FORMS AND CHECKLISTS I91
1 st shift or s i n g l e shift 2 nd shift
I !..1..1. 1 Iill I li]llilil

TASK ................................................ risk s c o r i n g risk scoring
FREQUENCY F O R C E (BORG) POSTURE AND ' ELBOW M O V E M E N T S

SHOULDER MOVEMENTS
o
DESCRIPTION OF THE TECHNICAL
ACTIONS OF THE UPPER LIMBS
z I ~ =
( d i s t i n g u i s h i n g b e t w e e n left a n d right)
...... ]
RIGHT LEFT EXTREMEJOINT EXTREMEJOINT

SINGLE MOVEMENTSOR MOVEMENTS PER CYCLE
"BORG" MAINTENANCEFOR i PERIODS.EQUALTO:
VALUES
~ x 6 0 " - - - x - - - MULTIPLIED 41/3, 8 2/312 3/3 41/3.8 2/312 3/3 SUPINAT.
FREQUENCY CYCLE FREQUENCY/NET NO,ACTIONS OF CYCLE
BY TIME 21/3.4 2/3 6 3/3 PRONATZ.
CYCLERIGHT TIME MINUTE OPERATION INSHIFT
RIGHT TIME/SHIFTI FRACTION OPERATOR MAKES
L i 2 1/3.4 2/3 6 3/3 FLEXION
OF SAME GESTURESFOR 50%OF
SCORE
DURATION THE TIME. OR KEEPSARMS OPERATORPERFORMS
FORCE
CONSTANTLYUPLIFTEDBY GESTURESOF SAMETYPE
• 9 = • = +20~ FOR AT LEAST50% OF CONTINUOUSLYFOR AT
FREQUENCY CYCLE FREQUENCYNET NO.ACTIONS CYCLE TIME: 4 LEAST 50% OF CYCLE4
CYCLELEFT TIME MINUTE OPERATION INSHIFT R
LEFT TIME/SHIFr SCORE R SCORE R
SCORE
FORCE SHOULDER ELBOW
L L
I9 2 RISK ASSESSMENT AND MANAGEMENT OF REPETITIVE MOVEMENTS AND EXERTIONS OF UPPER LIMBS
3 '~ S H I F T
RISK SCORE
- ~ ' ~ wins'r ' P O S T U ' I ~ AND HAND M O ~ ADDmONAL FACTORS

MOV'I~t~TS
' I
MOVINOOR MAINTAININOJOINTS FOR A N Y A D D r n O N A L FACTOR INDICATED FOR C Y C L E

1N EXTREMEFOSITIONSFORCYCLE PERKX)S:
'.~ OF: ~m. I~, I~ ~ ~
,rim. [g~ IN ~
I/3, 2/3, 3/3 ~ U P WIDE ~ T~ o~Rs. ~ se~.s c~ v~v ~oM i m4.
D~'. Elux m 2 a . r a ~
ADDIllONAL FACTOR SCORE

L
9AT1,2~gF~0%OFTI~ CYCL,BTII~B:
HAND R
L
CALCULATION OF OCRA EXPOSURE INDEX
RIGHT ARM LEFT ARM

9 Action freauencv constant (no. of actions/minJ) 30 30 30 30 30 30 30 30 C.F.
9 Force factor (perceived effort1
BORG 0.5 1 1.5 2'" 2.5 3 3.5 4 4.5 5 A B C D A B C D Taslds
FACTOR 1 0.85 0.75 0.85 0.55 0.45 0.35 0.2 0.1 0.01 Ff
x
9 Postural factor A B C D A Taslds
VALUE 0-3 4-7 8-11 12-15 16 ELBOW between elbow, wrist

and hand
FACTOR 1 0.70 0.60 0.50 0.33 WRIST
HAND Fp
VALUE o 4 8 12 A B C D A B C D TaskJsi
FACTOR 1 0,'95 0.90 0.80 Fc

x
A B C D A D Task/s
9 Duration of repetitive task
IB RIGHT LEFT
i
lk
no. recommended actions for repetitive.
ta~k, and in tota! (partial result, without
Recovery factor) 13 ~ 6 a 13 y 8
I
(a+13*y+~) (a*13+~+~)
HOURS 0 1 2 3 4 5 e 7 e Fr
FACTOR 1 0.00 0.80 0.70 0.60 0 . 4 5 0 . 2 5 0.10 0 I ......
....
9 factor referring to overall duration of repetitive tasks

RIGHT LEFT
MINUTES < 120 120 - 239 240 - 480 > 480 Fd = Arp=~x F r x Fd Arp -- ~ x Fr x Fd
F,OTO I I ! , ! i
i
Total no. of actions observed in repetitive tasks Ae
LE, ~
No. recommended actions Arp

OCRA CHECK LIST

A SHORTENED PROCEDURE FOR THE IDENTIFICATION
OF UPPER LIMB OVERLOAD IN REPETITIVE TASKS
COMPILED BY ....................................................................... Date .....................................................
NAME AND SHORT DESCRIPTION OF WORK-PLACE
NO. OF WORK-PLACE I I
TYPE OF W O R K INTERRUPTION (WITH PAUSES OR OTHER VISUAL CONTROL TASKS) (max. score
allowed = 10). Choose one answer. It is possible to choose intermediate values.
~ ] - THERE IS AN INTERRUPTION OF AT LEAST 5 MINUTES EVERY HOUR IN THE REPETITIVE WORK
(ALSO COUNT THE LUNCH BREAK).
I-T] - THERE ARE 2 INTERRUPTIONS IN THE MORNING AND 2 IN THE AFTERNOON (PLUS THE LUNCH
BREAK), LASTING AT LEAST 7-10 MINUTES ON THE 7-8 HOUR SHIFT, OR AT LEAST 4
INTERRUPTIONS PER SHIFT (PLUS THE LUNCH BREAK), OR FOUR 7-10 MINUTE INTERRUPTIONS
IN THE 6-HOUR SHIFT.
~ ] - THERE ARE 2 PAUSES, LASTING AT LEAST 7-10 MINUTES EACH IN THE 6-HOUR SHIFT (WITHOUT
LUNCH BREAK); OR, 3 PAUSES, PLUS THE LUNCH BREAK, IN A 7-8-HOUR SHIFT.
- THERE ARE 2 PAUSES, PLUS THE LUNCH BREAK, LASTING AT LEAST 7--10 MINUTES EACH
OVER A 7-8 HOUR SHIFT (OR 3 PAUSES WITHOUT THE LUNCH BREAK), OR 1 PAUSE OF AT
LEAST 7-10 MINUTES OVER A 6-HOUR SHIFT.
[~] - THERE IS A SINGLE PAUSE, LASTING AT LEAST 10 MINUTES, IN A 7-HOUR SHIFT WITHOUT
LUNCH BREAK; OR, IN AN 8-HOUR SHIFT THERE ONLY IS A LUNCH BREAK (THE LUNCH BREAK
IS NOT COUNTED AMONG THE WORKING HOURS).
~-~ - THERE ARE NO REAL PAUSES EXCEPT FOR A FEW MINUTES (LESS THAN 5) IN A 7 TO 8-HOUR SHIFT.
I i RECOVER Y
NOTES:
PLEASE NOTE: it is useful to attach to the Check-list a map of the department, where the position and the number of the
work-place examined can be marked.
A D D E N D U M : FORMS A N D CHECKLISTS 195
Form1
ARM ACTIVITY AND WORKING FREQUENCY WITH WHICH THE CYCLES ARE PERFORMED (IF
NECESSARY, INTERMEDIATE SCORES CAN BE CHOSEN) (max. score possible = 10) choose one answer.
(state whether left or right arm is involved the most)
- ARM MOVEMENTS ARE SLOW, AND FREQUENT SHORT INTERRUPTIONS ARE POSSIBLE (20
ACTIONS PER MINUTE).
- ARM MOVEMENTS ARE NOT TOO FAST, ARE CONSTANT AND REGULAR. SHORT INTERRUPTIONS
ARE POSSIBLE (30 ACTIONS PER MINUTE).
- ARM MOVEMENTS ARE QUITE FAST, AND REGULAR (ABOUT 40), BUT SHORT INTERRUPTIONS
ARE POSSIBLE.
- ARM MOVEMENTS ARE QUITE FAST AND REGULAR, ONLY OCCASIONAL AND IRREGULAR
SHORT PAUSES ARE POSSIBLE (ABOUT 40 ACTIONS PER MINUTE).
- ARM MOVEMENTS ARE FAST. ONLY OCCASIONAL AND IRREGULAR SHORT PAUSES ARE
POSSIBLE (ABOUT 50 ACTIONS PER MINUTE).
- ARM MOVEMENTS ARE VERY FAST. THE LACK OF INTERRUPTIONS PACE MAKES IT DIFFICULT
TO HOLD THE PACE , WHICH IS ABOUT 60 ACTIONS PER MINUTE.
- VERY HIGH FREQUENCIES, 70 ACTIONS PER MINUTE, OR MORE. ABSOLUTELY NO
INTERRUPTION ARE POSSIBLE
FREQUENCY
PRESENCE OF WORKING ACTIVITIES INVOLVING THE REPEATED USE OF FORCE IN THE HANDS-
ARMS (AT LEAST ONCE EVERY FEW CYCLES DURING ALL THE TASK ANALYSED): r-I YES I-] NO
More than one answer can be ticked: add up the partial scores obtained. If necessary, choose
intermediate scores, and then add them together (describe the limb which is most involved, the
same one for which the posture will have to be described).
IF YES:
THIS WORKING TASK IMPLIES: r~ - ONCE EVERY FEW CYCLES
[] THE HANDLING OF OBJECTS WEIGHING OVER 3 K G
[] GRIPPING BETWEEN FOREFINGER AND THUMB, AND LIFTING, - ONCE EVERY CYCLE
OBJECTS WEIGHING OVER 1 K G (IN PINCH)
[] USING THE WEIGHT OF THE BODY TO OBTAIN THE NECESSARY [~ - ABOUT HALF OF THE CYCLE
FORCE TO CARRY OUT A WORKING ACTION
- FOR OVER HALF OF THE CYCLE
[] THE HANDS ARE USED AS TOOLS TO HIT OR STRIKE SOMETHING
THE WORKING ACTIVITY REQUIRES THE USE N OF INTENSE FORCE

- 1/3 OF THE TIME
FOR:
[] PULLING OR PUSHING LEVERS
- ABOUT HALF OF THE TIME
[] PUSHING BUTTONS
[] CLOSING OR OPENING - OVER HALF OF THE TIME (*)
[] PRESSING OR HANDLING COMPONENTS
H ~ .- N E A R L Y A L L THE TIME (*)
[] USING TOOLS
[]
...................................................................................
THE WORKING ACTIVITY REQUIRES THE USE OF MODERATE FORCE r~ - 1/3 OF THE TIME
FOR:
[] PULLING OR PUSHING LEVERS - ABOUT HALF THE TIME
[] PUSHING BUTTONS
[] CLOSING OR OPENING - OVER HALF THE TIME
[] PRESSING OR HANDLING COMPONENTS
[] USING TOOLS r~ - NEARLY ALL THE TIME
[]
....................................................................................
Form2
PRESENCE OF AWKWARD POSITIONS OF THE ARMS DURING THE REPETITIVE TASK
(highest possible score = 11): !-7 RIGHT 1-1 LEFT !--I BOTH (mark the limb with greater
involvement)
i..,,,,.i
- THE ARM/ARMS ARE NOT LEANING ON THE WORKBENCH BUT ARE A LITTLE UPLIFTED FOR A
LITTLE OVER HALF THE TIME
- THE ARMS HAVE NOTHING TO LEAN ON AND ARE KEPT NEARLY AT SHOULDER HEIGHT FOR
ABOUT 1/3 OF THE TIME
r ~ - THE ARMS ARE KEPT AT ABOUT SHOULDER HEIGHT, WITHOUT SUPPORT, FOR OVER HALF THE
TIME
- THE ARMS ARE KEPT AT ABOUT SHOULDER HEIGHT, WITHOUT SUPPORT, ALL THE TIME
IA
- THE WRIST MUST BEND IN AN EXTREME POSITION, OR MUST KEEP AWKWARD POSTURES (SUCH
AS WIDE FLEXIONS OR EXTENSIONS, OR WIDE LATERAL DEVIATIONS) FOR AT LEAST 1/3 OF THE
TIME
[ ~ - THE WRIST MUST BEND IN AN EXTREME POSITION, OR MUST KEEP AWKWARD POSTURES (SUCH AS
WIDE FLEXIONS OR EXTENSIONS, OR WIDE LATERAL DEVIATIONS) FOR OVER HALF OF THE TIME
- THE WRIST MUST BEND IN AN EXTREME POSITION, ALL THE TIME I ...... IB
~'1 " THE ELBOW EXECUTES SUDDEN MOVEMENTS (JERKING MOVEMENTS, STRIKING MOVEMENTS)
- THE ELBOW EXECUTES SUDDEN MOVEMENTS (JERKING MOVEMENTS, STRIKING MOVEMENTS)
[ ~ - THE ELBOW EXECUTES SUDDEN MOVEMENTS (JERKING MOVEMENTS, STRIKING MOVEMENTS)
NEARLY ALL THE TIME IC
GRIP O B J E C T S , P A R T S OR T O O L S WITH F I N G E R T I P S

r-i WITH CONSTRICTED FINGERS (PINCH);
l-q WITH THE HAND NEARLY OPEN
(PALMAR GRIP) ALL THE TIME
I-1 KEEPING FINGERS HOOKED I ID
PRESENCE OF IDENTICAL MOVEMENTS OF SHOULDER AND/OR ELBOW, AND/OR WRIST, AND/OR HANDS, E I~1
REPEATED FOR AT LEAST 2/3 OF THE TIME (please cross 3 also if the cycle is shorter than 15 seconds)
PLEASE NOTE: use the highest value obtained among the four groups of questions (A,B,C,D) only once, and if possible add
to that of the last question E
. . . .
POSTURE
9 PRESENCE OF ADDITIONAL RISK FACTORS: only choose one answer per group of questions
F 2"~- GLOVES INADEQUATE TO THE TASK ARE USED FOR OVER HALF THE TIME (UNCOMFORTABLE, TOO THICK, WRONG
SIZE, ETC.)
~] - VIBRATING TOOLS ARE USED FOR OVER HALF THE TIME
~ ' ~ - THE TOOLS EMPLOYED CAUSE COMPRESSIONS OF THE SKIN (REDDENING, CALLOSITIES, BLISTERS, ETC.)
~ ' } - PRECISION TASKS ARE CARRIED OUT FOR OVER HALF THE TIME (TASKS OVER AREAS SMALLER THAN 2 OR 3 MM)
- MORE THAN ONE ADDITIONAL FACTOR IS PRESENT AT THE SAME TIME (I.E.............................................................. )
AND, OVERALL, THEY OCCUPY OVER HALF THE TIME
~ ' ~ - ONE OR MORE ADDITIONAL FACTORS ARE PRESENT, AND THEY OCCUPY THE WHOLE OF THE TIME (I.E .................... )
- WORKING PACE SET BY THE MACHINE, BUT THERE ARE "BREATHING SPACES" IN WHICH THE WORKING RHYTHM
CAN EITHER BE SLOWED DOWN OR ACCELERATED
- WORKING PACE COMPLETELY DETERMINED BY THE MACHINE
---] ADDITIONAL
ADDENDUM" FORMS AND CHECKLISTS I97
Form3
9 PRESENCE OF WORKING ACTIVITIES WITH TASKS ORGANISED IN CYCLES (CYCLE = GROUP OF

ACTIVITIES WITH UPPER LIMB MOVEMENTS THAT REPEAT THEMSELVES EVERY FEW SECONDS
OR MINUTES, AND ARE ALL THE SAME) - it is possible to choose more than one answer
I-1 FOR AT LEAST 2-3 HOURS IN THE WORK SHIFT

r-I FOR AT LEAST 4-5 HOURS IN THE SHIFT
r-I FOR 6-8 HOURS, OVERALL, IN THE SHIFT
1-1 WORK BY INCENTIVES
FI USUAL WORK OVER HOURS
CALCULATING THE EXPOSURE INDEX FOR REPETITIVE TASKS
To calculate the task index, add the values in the 5 boxes "Recovery + Frequency * Force + Posture, +
Additional If there is more than one repetitive task carried out during the shift, use the following equation to
obtain the overall score for repetitive work during the shift (% PA = percentage of time for task A during the shift)
(score A x % P A ) + ( score B x % PB) + etc.
---] EXPOSURE INDEX
PLEASE NOTE: = FOR PART-TIME JOBS LASTING ONLY 2 HOURS IN THE REPETITIVE WORK SHIFT, MULTIPLY THE
FINAL VALUE OF THE CHECK-LIST BY 0.50 FOR PART-TIME JOBS LASTING 3-5 HOURS IN THE REPETITIVE WORK
SHIFT, MULTIPLY THE FINAL CHECK-LIST VALUE BY 0.75
TASKS CARRIED OUT DURING THE SHIFT, AND/OR NAME OF THE WORK PLACE
NAME OF WORKPLACE DURATION (min) PREVALENCE OF SHIFT (P)

A ........................................................... ....................................... (PA)
g ........................................................... .............................................................................. PB)
C ........................................................... .............................................................................. (PC)
D ........................................................... .............................................................................. (PD)
C O - R E S P O N D E N C E OF SCORES BETWEEN OCRA AND CHECK-LIST SCORES
CHECK LIST OCRA
UPTO A 6 GREEN LIGHT, YELLOW/GREEN LIGHT = NO RISK
61 - 119 21 - 3 9 YELLOW/RED LIGHT = LOW RISK
1 2 - 189 4-7.9 MEDIUM RANGE = MEDIUM RISK
>19 >8 HIGH RANGE = HIGH RISK

Appendix
QUESTIONNAIRE FOR WORKERS

WITH WORK RELATED MUSCULOSKELETAL DISORDERS (WMSDs)
DW Mmm Ym,
DATE OF EXAMINATION: I. I.__II._I._.I l . g _ . l DATAV
NAME and SURNAME IJJJJJJ_I_IJJJJJJJJJJ_LLIJJJJJJJJJJJ

DATE OF BIRTH: Igg LLI LLI ~T^ SEX ~,t F-2 L I =EX
CURRENT DEPARTMENT: I_.1_.1.._1._1__1.._1__1_.1 .I.._1__1 RF.PA EMPLOYEE REF. No. I.._1__1__1._1__1. I
CURRENT UNE (OR OTHER WORKSTATION) I.g__l_ I._1...I g LK=~
[ 1 ] PERFORMS RE-DESIGNED JOB (approx. 20 actions/minute) OR ALREADY OPTIMAL JOB I__1

[ 2 ] PERFORMS NON RE-DESIGNED JOB RIPRO
ijjj
IF PERFORMING RE-DESIGNED OR OPTIMAL JOB: HOW LONG IN THIS JOB? RIPROME
cURI~ENT EXAMINATION
[ 1 ] ............................ [ 2 ] ............................ [3]...

c(~o
UPPER EXTREMITY SYMPTOMS REPORTED BY WORKER RELATIVE TO LAST 6 MONTHS
LEFT SHOULDER RIGHT SHOULI;)ER

[ 1 ] SYMPTOMS COMPLETELY DISAPPEARED [ 1 ] SYMPTOMS COMPLETELY DISAPPEARED SPALLAD

[ 4 ] SITUATION UNCHANGED BY PREV. WORSENING [ 4 ] SITUATION UNCHANGED BY PREV. WORSENING I._1
[ 5 ] SYMPTOMS WORSENED [ 5 ] SYMPTOMS WORSENED SPALLAS
,, i
COMMENTS: ..............................................................................................................................................................................
! ! i i i i
LEFT ELBOW RIGHT ELBOW
IF PREVIOUSLY POSITIVE: IF PREVIOUSLY POSITIVE: I

..._. I
[ 1 ] SYMPTOMS COMPLETELY DISAPPEARED [ 1 ] SYMPTOMS COMPLETELY DISAPPEARED GOMID

[ 4 ] SITUATION UNCHANGED BY PREV. WORSENING [ 4 ] SITUATION UNCHANGED BY PREV. WORSENING I I
[ 5 ] SYMPTOMS WORSENED [ 5 ] SYMPTOMS WORSENED GOMIS
COMMENTS: ..............................................................................................................................................................................
i i
LEFT HAND/WRIST/FINGERS RIGHT HAND/V~/RIST/FINGERS
IF PREVIOUSLY POSITIVE: IF PREVIOUSLY POSITIVE:
[ 1] SYMPTOMS COMPLETELY DISAPPEARED [ 1] SYMPTOMS COMPLETELY DISAPPEARED

[2] SYMPTOMS IMPROVED [2] SYMPTOMS IMPROVED
[3] SITUATION UNCHANGED BY PREV. IMPROVEMENT [3] SITUATION UNCHANGED BY PREV. IMPROVEMENT
[4] SITUATION UNCHANGED BY PREV. WORSENING [4] SITUATION UNCHANGED BY PREV. WORSENING I I
[5] SYMPTOMS WORSENED [5] SYMPTOMS WORSENED POLSOO
[6] ONSET OF NEW SYMPTOMS IN PREVIOUSLY [6] ONSET OF NEWVSYMPTOMS IN PREVIOUSLY
ASYMPTOMATIC SUBJECT, W/TH FOLLOWING ASYMPTOMATIC SUBJECT, WITH FOLLOWING
CHARACTERISTICS: CHARACTERISTICS: I__1
[ ] NOCTURNAL PARAESTHESIA AND/OR PAIN [ ] NOCTURNAL PARAESTHESIA AND/OR PAIN POLSOS
(during daytime rest in shift worker) (dudng daytime rest in shift worker)
(continuous or sub-continuous; at least one episode (continuous or sub-continuous; at least one episode
per week over the last 3 months) per week over the last 3 months)
[ ] CONTINUOUS OR SUB CONTINUOUS DIURNAL [ ] CONTINUOUS OR SUB CONTINUOUS DIURNAL
PAIN (at least 5 episodes in the last 6 months) PAIN (at least 5 episodes in the last 6 months)
LOCATION: [ ] WRIST LOCATION: [ ] WRIST
[ ] FIRST DIGIT [ ] FIRST DIGIT
[ ] OTHER [ ] OTHER
COMMENTS: EMPLOYEE'S SIGNATURE:
.............................................................................................
iiii i i i i ill II I
i i ii
DIAGNOSTIC LINK
KIND OF PATHOLOGY: DIAGNOSIS:

.............................................................................................................................................................................
I I LIGHT
I I MEDIUM LLLI
ARUNO
I I HEAVY
I I I I
ARDUE
Illl
~ E
I I I I
l I I
ARQUA
~_I_L_i
ARCIN
I_L_LJ
ARSEI
SUMMARY SYMPTOM-NEGATIVE [ 1] SHOULDER
[2] ELBOW
[4] WRISTS/HANDS/FINGERS
[8] POSITIVE FOR ALL JOINTS I I I I
[0] ALL JOINTS NEGA
REFERRALS REQUIRED:
[0]NO [ 1] YES
I I
[ ] PHYSIOTHERAPY ] ...................................... V~A
[ ] NEUROLOGICAL
[ ] X-RAY
[ ] EMG
ASSESSMENT OF WORKER'S CURRENT DUTIES:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The worker's current job is at risk of:

- awkward posture of the [ ] shoulder [R] [L]
[ ] elbow [R] [L]
[ ] wrist [R] [L]
- excessive force on upper limb [R] [L]
- force and discomfort when lilting containers [ ] YES
[ ]NO
OPERATIONAL LINK FOR TECHNICAL PERSONNEL
[oo] EXCLUDE FROM WMSDs GROUP UNDERGOING HEALTH SURVEILLANCE

[ l o ] CAN REMAIN IN NON RE-DESIGNED JOB (PRESENT WORK STATION)
I_.l__l
OPERA
[20] MUST REMAIN IN RE-DESIGNED JOB (OR OPTIMAL JOB FOR WMSDs)
[30] MUST BE TRANSFERRED TO RE-DESIGNED JOB FOR WRIST AND ELBOW
[31] MUST BE TRANSFERRED TO RE-DESIGNED JOB FOR SHOULDER
[32] MUST BE TRANSFERRED TO RE-DESIGNED JOB FOR WHOLE UPPER LIMB
[40] REVIEW WORK-STATION, EVEN IF RE-DESIGNED, FOR WRIST/ELBOW AREA
[41] REVIEW WORK-STATION, EVEN IF RE-DESIGNED, FOR SHOULDER AREA
[42] REVIEW WORK-STATION, EVEN IF RE-DESIGNED, FOR WHOLE UPPER LIMB
[50] MODIFIED WORK-STATION BUT NOT FOR WMSDs
I.____1 USE A WORK-STATION WITHOUT MANUAL MATERIAL HANDLING I.._1 SPINE

Foreword: Prof. Antonio Grieco

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FOREWORD

This book is somewhat unusual for several reasons.

Prof. Antonio Grieco

This is only the beginning!

The program is available over the Intemet" http://www.elsevier.com/locate/colombini

Definition and aims of ergonomics

Fields of application within the european technical regulation

The tasks of the Time and Methods analyst

Involvement and responsibility: the new frontiers of industrial work

Contents and scope of the handbook

Table 2.1 - Main acronyms used

WMSD Work related Musculo Skeletal Disorders

- Shoulder tendinitis or scapulo-humeral periarthritis

Type of study Effect measurements Bibliography

Table 2.4 - Lateral epicondylitis A comparison by study design and job

Type of study Effect measurements Bibliography

n.v. = significance not assessed

Table 2.5 - Hand~wrist tendinitis. A comparison by study design and job

Type of study Effect measurements Bibliography

n.v. = significance not assessed;

Type of study Effect measurements Bibliography

n.v. = significance not assessed;

Type of study Effect measurements Bibliography

Thoracic outlet syndrome

Tension neck syndrome

W M S D prevalence data over an italian reference sample

Suspect thoracic outlet syndrome 0 1 0.3 2 0.6 5 1

Suspect thoracic outlet syndrome 0 1 0.6 2 0.6 5 1.9

Total WMSDs 3.9

Pathogenesis of WMSDs tissue alterations

Causing factors (non-exhaustive list)

Repetitive movements Gender

Table 2.11 - Pathogenesis o f tendon and nerve disorders

OCRA Risk Index

- accurate operator exposure levels;

Company technical team

Study of the risk~damage relationship for individuals who

Census and analysis of work-places where risk is absent

Table 3.2- Possible risk signals

The general model for exposure analysis and related definitions

a) high action frequency (repetitiveness 1);

Table 4.1 - Definition of the principle terms used in exposure evaluation

9 grasping and placing;

Table 4.2 - Terminology used by the Times and Methods analyst

Table 4.2- Continued

Table 4.2 - Continued

Checklist 5.1.A (Example 5.A)

INFORMATION ON JOB ORGANIZATION

N A M E / S ...... AC, GP, DA, GH, BP, BB, CF...........................................................................................

9 Duration of shift/s I~ 1st shift from...6AM...; to 2.30PM...; minutes...480

2 nd shift from...2.30PM; to 11PM ...... 9 minutes ......

I--I minutes (2 nd shift) ...38.4 .........

Are physiological recoveries and/or rest factors distributed subjectively?

Meal break 30 min. 11-11.30 AM 30 min. 7.30-8 PM

1st break 15 min. 7.30-7.45 AM 15 min. 3.45-4 PM

I st shift 2 nd shift 3 rd shift S i n g l e shift

Checklist 5.2.A (Example 5.A)

LIST OF OPERATIONS PERFORMED DURING THE SHIFT

17 In cycles A WELD BRACKET (70%) ........ 225.2 ................

B PUNCH END HOLE (30%) ......... 9 6 . 4 . . . . . . . . . . . . . . . . .

I---I Not in cycles X supply 10%

Y prepare 10% . . . . . . . . . . 8 IIOOOIIO. . . . . . . . .