Inspection Checklist for Ergonomic Risk Factors

Date: Time: Employee observed:

Job title: Task:

Task description:

Found InThis
RISK FACTORS Cause/Description Possible Solutions
Task

Repetition

Repeated forceful or awkward motions

Little or no rest
Using same body part repeatedly

Awkward Posture

Bending or leaning forward

Reaching or lifting below knee level

Twisting or bending to the side

Reaching above chest level

Bending wrist frequently

Twisting hands or forearms

Raising arms to side or forward

Bending neck

Forceful Motion

Lifting, pushing, or pullingmore

than 50 pounds
Lifting more than six pounds with one hand
Forceful gripping of material or tools

Handling tools or material in pinch grip

Inspection Checklist for Ergonomic Risk
Factors
Found InThis
RISK FACTORS Cause/Description Possible Solutions
Task

Stationary Position

Working in one position for long periods

Standing for long periods

Sitting for long periods

Direct Pressure

Tool or equipment pressing on hand or body

Seat or table pressing on leg or body

Vibration

Using vibrating hand tools

Operating vibrating heavy equipment

(including large vehicles)

Temperature and Environment

Temperature too hot or too cold

Workplace poorly lit

Walkways obstructed or slippery

Work stress

Pace of work is machine-controlled

Piece work is used as production incentive

Insufficient work breaks

Poor supervision

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 Maximum Exposure Duration
(continuously or Illustration Yes No
Body Part Physical Risk Factor
cumulatively)

Working with More than 2

hands above the hours per day
head OR the
elbow above the
shoulder

Working with More than 2

shoulder raised hours
per day

Work More than 2

repetitively by hours per day
Shoulders raising the hand
above the head
OR the elbow
above the
shoulder more
than once per
minute

Working with More than 2

head bent hours per day
downwards more
than 45 degrees
 Working with More than 2
head bent hours per day
backwards

Working with More than 2

head bent hours per day
sideways

Head

Working with More than 2

back bent hours per day
forward more
than 30 degrees
OR bent
sideways

Working with More than 2

back bent hours per day
forward more
than 30 degrees
OR bent
Back sideways

Working with More than 2

body twisted hours per day

Flexion
Working with
More than 2
Hand wrist flexion OR
hours per day
extension OR
radial deviation

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 more than 15 Extension
degrees

Working with More than 4

arm abducted hours per day
sideways

Working with
arm extended
forward more
than 45 degrees
More than 2
OR arm
hours per day
extended
backward more
Hand/ than 20
Elbow/ Wrist degrees.

Work in a squat More than 2

position. hours per day

Work in a More than 2

kneeling position hours per day
 Accident Prevention Plan Review Checklist
Company Name:
Jobsite Address:
Supervisor:
Date:
Inspector(s):

Worksite General

Check Items Inspected: Yes NO NA

Worksite General
Are safety signs/warnings posted where appropriate?
Are emergency telephone numbers posted where they can
be found readily?
Is a first aid kit available and adequately stocked?
Is a summary of Occupational Illnesses posted?
Management Component
Is there a written safety policy statement?
Are individual(s) responsible for development,
implementation, and enforcement of the accident
prevention plan?
Are employee/supervisor responsibilities and authority
assigned?
Is a safety team established to monitor your safety and
accidents investigations program?
Record Keeping Component
Are OSHA 300/301 being maintained as required?
Are procedures in place to maintain records and logs?
Safety inspections
Safety meeting minutes
Accident investigations
Are employee medical records up-to-date and in accordance with
OSHA standards?
Are operating permits and records current?
Analysis Component
Has a job safety analysis been conducted?
Has an accidents trend analysis been conducted?
Is there an established time frame for analysis (monthly,
quarterly, semi-annually, annually)?
Are analysis records maintained and current?
Does the insurance loss run information match your
records?
Has the accident prevention program documentation been
reviewed for completeness?
Is a responsible person designated for analysis?
Health & Safety Training Component
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Does management provide resources and participate in
employee training?
Have employees received instruction on reporting
procedures to report unsafe conditions, defective
equipment, and unsafe acts?
Have supervisors received instruction in accident
investigation and hazard abatement?
Accident prevention signs and tags
Are procedures established to ensure that inspection
deficiencies are corrected?
Accident Investigation Component
Have accident investigation guidelines been established?
Are responsibilities assigned for all phases of the
investigation process?
Who is responsible for conducting investigations?
Who completes the accident investigation report?
Who ensures corrective actions are implemented and
effective?
Are all accidents and “near misses” investigated?
Are accident investigation recommendations implemented?
Who completes records/logs?
What forms are used?
Are the personnel involved in the investigation process
trained in investigation techniques and procedures?
Is a responsible person designated to investigate?
Periodic Review and Revision Component
Is your accident prevention plan reviewed at least
annually?
Are results documented and shared with
management/supervisors/ employees?
Who conducts the review?
Corrective Actions
Are deficiencies found by this review, proposed corrective
actions, and commitment dates described in attached
documents?