This audit helps identify ergonomic risk factors in your home workspace. Accurate information ensures personalized recommendations to reduce strain and improve comfort.
Full Name
Email Address
Occupation or Job Title
How many days per week do you work from home?
5 days (Full-time)
4 days
3 days
2 days
1 day
Occasionally (less than 1 day/week)
Average daily work hours (excluding breaks)
What is your primary work device?
Desktop computer
Laptop
Tablet
Multiple devices (laptop + external monitor)
Multiple devices (other combination)
Do you use an external monitor, keyboard, or mouse with your laptop?
Which external peripherals do you use?
External monitor
External keyboard
External mouse
Laptop stand
⚠️ Using a laptop without external peripherals significantly increases ergonomic risk. Consider adding at least an external keyboard and mouse.
Which external peripherals do you use?
External monitor
External keyboard
External mouse
Laptop stand
What type of seating do you primarily use for work?
Ergonomic office chair (adjustable)
Basic office chair (limited adjustment)
Dining/kitchen chair
Stool or barstool
Sofa or couch
Bed
Other
How old is your primary chair (in years)?
Which adjustment features does your chair have? Select all that apply.
Height adjustment
Adjustable armrests (height/width)
Lumbar support adjustment
Seat depth adjustment
Tilt tension/recline
Headrest
360° swivel
No adjustments available
Is your chair's lumbar support functional and properly positioned?
Please describe the issue with your lumbar support:
What type of desk or work surface do you use?
Electric height-adjustable desk
Manual height-adjustable desk
Fixed-height desk (standard 28-30 inches)
Fixed-height table (non-standard height)
Dining table
Coffee table
Couch/bed with lap desk
Other
How many monitors do you use?
Single monitor
Dual monitors
Triple monitors
Laptop screen only
Laptop + external monitor
What type of keyboard do you primarily use?
Standard flat keyboard
Ergonomic/split keyboard
Mechanical keyboard
Laptop integrated keyboard
Compact/tenkeyless keyboard
None
What type of pointing device do you use?
Standard mouse
Ergonomic/vertical mouse
Trackpad
Trackball
Graphics tablet
None
Complete the table below to assess your primary workstation setup. Rate each component honestly based on your typical working posture. Add additional rows if you use multiple work locations. This analysis identifies specific risk factors contributing to back and neck strain.
Primary Workstation Ergonomic Assessment
Workplace Location | Seat Height Alignment | Lumbar Support Quality | Elbow & Keyboard Angle | End-of-Day Fatigue Score | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | Dedicated Home Office | Feet Flat on Floor/Knees 90° | 🟢 Firm Lower Back Curve | Level 90° Arms | ||
2 | Kitchen Dining Chair | Feet Dangling/Thigh Pressure | 🟡 Soft/Slouching | Reaching Up | ||
3 | Standing Desk Stool | Knees Above Hips | 🔴 No Support/Hollow | Shoulder Hunching | ||
4 | ||||||
5 | ||||||
6 | ||||||
7 | ||||||
8 | ||||||
9 | ||||||
10 |
Which of the following best describes your typical neck posture?
Neutral - ears aligned with shoulders
Forward head posture - head juts forward
Looking down at screen
Looking up at screen
Frequently rotating side to side
How are your wrists typically positioned when typing?
Straight and neutral
Bent upward (extension)
Bent downward (flexion)
Bent sideways (deviation)
Resting on wrist rest
What is the distance from your eyes to the primary screen (in inches)?
Where is the top of your primary screen relative to your eye level?
At or slightly below eye level (ideal)
2-4 inches below eye level
More than 4 inches below eye level
Above eye level
Significantly off-center
Do you experience shoulder tension or elevation while working?
How frequently does this occur?
Constantly throughout the day
Several times per hour
Occasionally
Only during high-stress periods
Precise measurements help identify specific misalignments. Use a tape measure if possible, or provide your best estimate.
Seat height from floor to seat pan (in inches)
Desk height from floor to work surface (in inches)
Monitor height from floor to top of screen (in inches)
Your height (in inches)
Can you adjust your chair height independently from your desk?
Consider using a footrest or desk risers to achieve proper alignment when seat height cannot be adjusted.
Do you take scheduled breaks from sitting?
How often do you take breaks?
Every 20-30 minutes (ideal)
Every 45-60 minutes
Every 1-2 hours
Every 2-3 hours
Irregularly
What prevents you from taking regular breaks?
Do you perform stretching exercises during work hours?
Which types of stretches do you regularly perform? Select all that apply.
Neck stretches and rotations
Shoulder blade squeezes
Upper back extensions
Spinal twists
Hip flexor stretches
Hamstring stretches
Wrist and forearm stretches
Ankle circles
What is the main barrier to stretching?
Lack of time
Don't know what stretches to do
Not a priority
No space
Forgetfulness
Physical limitations
How frequently do you change your sitting position or posture?
Every 10-15 minutes
Every 30 minutes
Every hour
Only when uncomfortable
Rarely - maintain one position
Do you use a standing desk or alternate between sitting and standing?
What percentage of your workday do you spend standing?
Do you walk or move during phone or video calls?
Which end-of-day activities help you recover from work-related strain? Select all that apply.
Light stretching routine
Walking or light exercise
Heat therapy (heating pad)
Cold therapy (ice pack)
Massage or foam rolling
Yoga or Pilates
Nothing specific
Other
Which areas experience pain, discomfort, or fatigue during or after work? Select all that apply.
Neck and cervical spine
Shoulders (trapezius)
Upper back (thoracic)
Lower back (lumbar)
Hips and glutes
Wrists and forearms
Eyes and forehead
No discomfort
Rate the average pain/discomfort level for each area (0 = no pain, 10 = severe pain)
Neck and cervical spine | |
Shoulders (trapezius) | |
Upper back (thoracic) | |
Lower back (lumbar) | |
Hips and glutes | |
Wrists and forearms |
When did you first notice work-related musculoskeletal discomfort?
Less than 1 month ago
1-3 months ago
3-6 months ago
6-12 months ago
More than 1 year ago
No discomfort
How does this discomfort impact your productivity and daily activities?
No impact
Minor distraction
Moderate impact - need to adjust position frequently
Significant impact - affects concentration
Severe impact - limits ability to work
Unable to perform some tasks
Have you consulted a healthcare professional for work-related pain?
Which types of professionals have you consulted? Select all that apply.
Primary care physician
Physiotherapist/Physical therapist
Chiropractor
Occupational therapist
Ergonomic specialist
Massage therapist
Acupuncturist
Have you received any formal ergonomic assessment or training?
Briefly describe the recommendations you received:
What is your primary source of lighting during work hours?
Natural light from window
Overhead ceiling light
Desk lamp/task lighting
Combination of natural and artificial
Insufficient lighting
Do you experience glare or reflections on your screen?
What are the sources of glare? Select all that apply.
Window or sunlight
Overhead lighting
Desk lamp
White walls or reflective surfaces
Uncertain
How is your foot positioning throughout the day?
Flat on floor or footrest (ideal)
Crossed legs
Feet on chair base
One foot under me
Dangling above floor
Do you use a document holder for reference materials?
How do you handle phone calls during work?
Hold phone to ear
Speakerphone
Wired headset
Wireless headset
Computer audio with microphone
Don't take calls
How would you describe your room temperature during work?
Too cold
Too hot
Comfortable and stable
Fluctuates throughout the day
Rate your average stress level during work hours (1 = no stress, 10 = extreme stress)
How often do you feel overwhelmed by your workload?
Never
Rarely (1-2 times/month)
Sometimes (1-2 times/week)
Often (3-4 times/week)
Daily
Do you feel you have control over your work schedule and breaks?
How clear is the boundary between work and personal time when working from home?
Very clear - I maintain strict separation
Somewhat clear
Unclear - work bleeds into personal time
Very unclear - constant overlap
Rate your current knowledge of ergonomic principles (1 = no knowledge, 10 = expert)
Which ergonomic topics would you like to learn more about? Select all that apply.
Chair setup and adjustment
Monitor positioning
Keyboard and mouse techniques
Stretching and exercises
Break scheduling
Standing desk usage
Lighting and vision
Stress management
Would you be interested in a personalized ergonomic improvement plan?
Rank these improvement areas by priority (1 = highest priority)
Upgrade office chair | |
Adjust monitor height/position | |
Improve break habits | |
Add stretching routine | |
Optimize keyboard/mouse setup | |
Improve lighting | |
Adjust desk height | |
Reduce overall work hours |
What is your approximate budget for ergonomic improvements (in USD)?
When do you plan to implement ergonomic changes?
Immediately (within 1 week)
Short-term (within 1 month)
Medium-term (1-3 months)
Long-term (3+ months)
No current plans
Rate your commitment to improving your workstation ergonomics (1 = not committed, 10 = fully committed)
Additional comments or specific concerns not covered in this audit:
How often would you like to complete this audit to track improvements?
Weekly for first month
Bi-weekly
Monthly
Quarterly
Annually
Only this once
Preferred method for receiving ergonomic tips and reminders?
SMS/text message
Calendar notifications
Mobile app
No reminders needed
May we contact you with personalized recommendations based on your audit results?
I consent to participating in follow-up research to improve ergonomic assessment tools
To configure an element, select it on the form.