Hours work per day: ____________________ 1. How often do you leave your workstation daily to perform other work related activities or for breaks? ___________________________ For approximately how long? ___________ 2. Do you have any current health concerns that you believe to be related to your work at your workstation? Yes No 3. If yes, check the area(s) of discomfort and circle the number which best describes the level (1= slight discomfort, 3=moderate, 5=significant pain)
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4. Do you experience eye strain from looking at the cashing screen? Yes No If yes, please describe symptoms and frequency: ___________________________________________________________________________ ___________________________________________________________________________ __________________________________________________________________________ 5. Do you experience a glare from the cashing screen?
Yes
No
6. How do you find the temperature at your workstation? Comfortable Too cold Too hot 7. How do you find the lighting at your workstation? Comfortable Too cold Too hot 8. How do you find the movement space at your work station? Can move freely without bouncing into objects Can move around well but may sometimes bounce into objects Very cramped and frequently bounce into objects 9. Do you have any other concerns about your current workstation that you think affects or may affect your health or safety? ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
10. Is it easy to report any concerns to your supervisor or manager?
Yes
No
11. Do you find 12. The medical conditions below may prompt an individual to be more prone to repetitive injury. If you have any of the listed conditions below, please indicate: Overweight
Pregnant
Rheumatoid Arthritis
Non-work related bone, joint or muscle injury
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Checklist for Identifying Potential Job-Specific Ergonomics Concerns - Cashiering (OSHA, US Department of Labour – Guidelines for Retail Grocery Stores)
Are items within easy reach?
Are keyboard supports adjustable?
Can the cashier work with items at about elbow height?
Can the display be read without twisting?
Are all edges smoothed or rounded so the cashier does not come into contact with sharp or hard edges?
Yes
Yes
No Yes
No
Yes
Yes
No
No
No
Are objects easily scanned the first time?
Yes
Are objects scanned without twisting hand motions?
Can cashiers scan heavy/bulky/awkward items without lifting them?
Are the scale, conveyor, and horizontal scanner plates all the same height?
Is the scanner plate clean and unscratched?
Does the cashier have an anti-fatigue mat and/or footrest?
Yes
No Yes
No Yes
No Yes
No
No Yes
No
Checklist for Identifying Potential Ergonomics Risk Factors by Workplace Activity
(OSHA, US Department of Labour – Guidelines for Retail Grocery Stores) Force in Lifting Does the lift involve pinching to hold the object?
Is heavy lifting done with one hand?
Yes
Yes
No
No
Are very heavy items lifted without the assistance of a mechanical device?
Yes
No
Are heavy items lifted while bending over, re aching above shoulder height, or twisting?
Yes
No
Are most items lifted rather than slid over the scanner? Repetitive Tasks Are multiple scans needed?
Yes
Yes
No
No
Is a quick wrist motion used while scanning?
Yes
No
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Do repetitive motions last for several hours without a break (e.g., slicing deli meats, scanning, groceries)?
Yes
No
Does the job require repeated finger force(e.g., kneading bread, squeezing frosting, using pricing gun)?
