Pre-Assessment Survey

Revised 2017.09.07

An essential part of the ergonomics process is getting input from those performing the tasks being examined.

“when compared to a trained expert, such as an ergonomist, front-line workers are able to provide more detailed information concerning social, organizational and physical hazards and how they relate”

Source: PSHSA Fast Facts: Ergonomic Program Implementation Continuum (PDF)

To help gather that input, the forms on this page may be completed by an individual with discomfort and/or difficulties related to their work, prior to an onsite consultation. Doing this ahead of time will reduce the duration of an onsite consultation and enable the individual to provide more thoughtful input.

1. For office/computer work:

Download and complete on your computer. [password required]

2. For non-office work:

Download, print and complete with pen and paper. [password required]

2.1. Background information: