Ergonomic Assessment Questionnaire Ergonomic Assessment Questionnaire Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Company *Gender *MaleFemaleDate of Birth *Length of Employment *Height (cm) *Desk Height (cm) *Rest Breaks (breaks/hr) *What type of computer do you predominantly work on? *DesktopLaptop BothIf you use a laptop, do you use an external keyboard and mouse? *YesNoAre you a proficient typist? *YesNoDo you use a numeric keypad? *YesNoHave you ever used or currently using any ergonomic equipment or tools at work? *YesNoIf you've answered "Yes" to the above please specify below:How many hours per day do you spend sitting at your desk/workstation using your laptop/desktop?Are you currently or have you previously experienced discomfort or pain while working at your current workstation? *YesNoIf you've answered "Yes" to the previous question, please specify where in your body you are or have experienced these symptoms (neck, shoulders, back etc.) *Submit
