Louisiana Administrative Code
Title 28 - EDUCATION
Part CXXXIII - Bulletin 1674 - Safety Manual for Career and Technical Education Programs
Chapter 31 - Ergonomics Worksheet
Subchapter B - Hazard Identification
Section CXXXIII-3111 - Evaluation

Circle the Appropriate Answer

1. Does the job require contact of fingers or wrist with sharp edges?

Y N N/A

2. Do hand tools or process equipment vibrate the worker's hands, arms, or whole body?

Y N N/A

Circle the Appropriate Answer

1. Does the job require more than 10 pounds of force?

Y N N/A

2. Does the job require using a pinch grip (between thumb and finger)?

Y N N/A

3. Are gloves used, increasing the force needed for motion of the fingers?

Y N N/A

4. Does the job require frequent heavy lifting ( 40 pounds, two hours per day)?

Y N N/A

5. Does the job require occasional very heavy lifting ( 50 pounds)?

Y N N/A

6. Does the job require handling items that are difficult to grasp?

Y N N/A

Circle the Appropriate Answer

1. Does the job require flexion or extension (bending up or down) of the wrist?

Y N N/A

2. Does the job require deviating the wrist side to side (ulnar or radial deviation)?

Y N N/A

3. Is the worker seated while performing the job?

Y N N/A

4. Does the job require "clothes wringing" motion?

Y N N/A

5. Does the job require extended reaches beyond normal arm reach?

Y N N/A

6. Does the job require awkward lifts or carries that are:

a. near the floor;

b. above the shoulders; or

c. far in front of the body?

Y N N/A

7. Does the job require exertion of pushing, pulling, lifting, or lowering forces in awkward positions to side, overhead, or at extended reaches?

Y N N/A

8. Do workers sit on the front edges of chairs?

Y N N/A

9. Is the worker required to maintain the same posture, either sitting or standing, all of the time?

Y N N/A

Circle the Appropriate Answer

1. Is the orientation of the work surface nonadjustable?

Y N N/A

2. Does the work surface appear to be too high or too low for many operators?

Y N N/A

3. Is the location of the tool nonadjustable?

Y N N/A

4. Does the job require handling oversized objects that require two-person lifting?

Y N N/A

5. Is there an absence of material handling aids, such as air hoists and scissors tables?

Y N N/A

6. Do workers attempt to modify their chairs or work surfaces by adding cushions or pads?

Y N N/A

Circle the Appropriate Answer

1. Does the job require that one motion pattern be repeated at a high frequency?

Y N N/A

2. Is the cycle time for repetitive operations less than 30 seconds?

Y N N/A

3. Is the work pace rapid and not under the operator's control?

Y N N/A

Circle the Appropriate Answer

1. Is the handle too large for the thumb and finger to slightly overlap around a closed grip?

Y N N/A

2. Is the span of the tool's handle less than 5 cm (2 inches)?

Y N N/A

3. Is the handle of the tool made of metal?

Y N N/A

4. Is the weight of the tool greater than 10 pounds?

Y N N/A

5. Are heavy tools lacking devices to suspend some of their weight?

Y N N/A

6. Does the use of the tool require flexion or extension of the wrist (bending up or down)?

Y N N/A

7. Does the tool require ulnar or radial deviation of the wrist (bending to either side)?

Y N N/A

Circle the Appropriate Answer

1. Are housekeeping practices poor, e.g., aisles cluttered, waste on the floor?

Y N N/A

2. Are floors uneven or slippery?

Y N N/A

3. Does the job require frequent (daily) stair or ladder climbing?

Y N N/A

4. Do the work tasks contain significant visual components, requiring good lighting?

Y N N/A

5. Does the worker's eye have to move periodically from dark to light areas?

Y N N/A

6. Is the air temperature uncomfortably hot or cold?

Y N N/A

Circle the Appropriate Answer

1. Are Video Display Terminals (VDT) Stations arranged so that lighting does not reflect directly off the screen?

Y N N/A

2. Do the seat and backrest of the chair support comfortable posture permitting occasional variation in the sitting positions?

Y N N/A

3. Is the seat height adjustable so that the entire sole of the foot rests on the floor or a footrest, and the back of the knee is slightly higher than the seat of the chair?

Y N N/A

4. Is the backrest height adjustable?

Y N N/A

5. Is the backrest angle adjustable?

Y N N/A

6. Is the workstation adjusted so that the wrist is in a straight line, i.e., not bent up or down?

Y N N/A

7. Is the topmost line of the screen slightly below eye level?

Y N N/A

8. Can the screen position be titled?

Y N N/A

9. Is the document holder positioned at the same height and at the same distance from the viewer as the screen?

Y N N/A

10. Is the work surface large enough to hold all needed reference material (at least 35 inches wide)?

Y N N/A

11. Can paper be easily and conveniently loaded into printers without the need for lifting heavy boxes in awkward postures?

Y N N/A

12. Does the screen have color, brightness, and contrast satisfactory with the operator?

Y N N/A

13. Does excessive illumination at the VDT produce glare or distortion of the screen or does low illumination make it difficult to read documents?

Y N N/A

14. Are characters on the screen clear and free of flicker or jitter?

Y N N/A

15. Is there adequate room under the work table to permit movement of operator's legs and footrest where necessary?

Y N N/A

16. Do task schedules allow the operator at least a 15 minute break period during each two-hour period?

Y N N/A