To be filled out and updated jointly by contractors and union reps — every 2 weeks or as a site changes. This document is intended to help develop an “eye” for ergonomic problems and prevent injuries.
Date:___/____/_____
Site: ___________
General contractor:___________
Union rep:___________
Subcontractor:___________
Signature:________________________________ (Person filling out this form)
Materials
Handling
What heavy materials or equipment are being handled on site — drywall, rebar, concrete forms, anything over 20 pounds?
Do any workers have to lift more than 50 pounds at one time without help?
Yes____
No____
Do workers have to lift more than 20 pounds often? If yes, how can this be changed?
Yes____ No____
Are there handles to help carry materials? If yes, are the handles easy to use and comfortable?
Yes____
No____
Yes____ No____
Are workers told to get someone’s help to lift heavy materials?
Are there carts, dollies, or other aids readily available for moving materials? If yes, are the carts being used? If no, why not?
Yes____
No____
Yes____
No____
Yes____
No____
If no, is the site clear enough to permit the use of carts?
Yes____ No____
Are materials delivered as close as possible to where they will be used? If no, how can this be changed?
Yes____
No____
On what jobs do workers have to lift overhead?
How can this lifting be avoided?
Are materials stored at floor or ground level? If yes, do workers have to bend down to lift materials?
Yes____
No____
Yes____
No____
Can the materials be stored at waist height?
Yes____ No____
On which tasks do workers have to stretch to pick up or lift materials?
Can the materials be kept closer?
Yes____ No
____
Tools
Are tools sharp and in good condition?
Yes____ No____
Which tools are very heavy or not well balanced?
Which tools vibrate too much?
Which tools must be used while in a difficult position?
Which tools have poor handle design?
grips too big or too small?
handles that are too short and dig into hands?
handles with ridges that dig into hands?
slippery handles?
Which tools require bending of wrists to use?
Do gloves ever make it hard to grip tools?
Yes____ No____
Are there other tools with a better design?
Yes____ No____
If yes, what are they?
Repetitive Work
Which tasks or jobs use the same motion dozens of times an hour for more than 1 hour per day?
What are the motions?
Can the number of repetitions be reduced by job rotation or rest breaks?
Yes____ No____
Awkward Postures
Which tasks involve work above the shoulders for more than 1 hour a day?
Can scaffolds, platforms, or other equipment cut down on the need to work overhead?
Yes____ No____
Which tasks or jobs involve work at floor level or on knees for more than 1 hour a day?
Are knee pads or cushions available and are they used?
Can equipment be used to reduce kneeling?
Yes____ No____ Yes____ No____
Which jobs require workers to stay in one position for a long time?
Can rotation or rest breaks be used to reduce time in awkward postures?
Yes____ No____
Which jobs require a lot of twisting or turning?
Which jobs require a lot of bending?
How can the need to twist or bend be reduced?
Standing
What jobs require workers to stand all day, especially on concrete floors?
Can
anti-fatigue matting be used?
Is it possible to use adjustable stools to allow workers to rest now and then?
Yes____ No____
Yes____ No____
Surfaces for Walking and Working
Are working and walking surfaces clean and dry?
Are the surfaces unobstructed?
Are the surfaces even?
Yes____
No____
Yes____
No____
Yes____
No____
Seating
What jobs require sitting all day?
Are the seats well-designed, easy to adjust, and comfortable?
In heavy equipment, do workers have to lean forward to see/do their work?
Does the seating in any heavy equipment vibrate a lot?
Yes____ No____
Yes____ No____
Yes____ No____
Production pressures
Do any workers work piece rate?
Yes____ No____
Have supervisors or workers been under production pressures that could lead
to shortcuts and injuries?
Yes____ No____
How could this problem be reduced? More rest breaks?____
More safety meetings?____
A special safety rep on site?____
Other____
Training
What training have workers had on ergonomics — preventing musculoskeletal disorders?
What training have supervisors had on ergonomics — preventing musculoskeletal disorders?
Musculoskeletal
Do workers feel free to report symptoms?
Yes____ No____
Have any workers been reporting muscle pain, tingling, numbness, loss of strength, or loss of joint movement?
Yes____ No____
If
yes, where?
Back____ Neck____ Shoulder____ Arm____ Wrist____ Knee____
Which trades have the most problems?
And what may be the main cause(s)?
Repetitive motion____
Awkward
postures_______
Fixed postures
____
Heavy lifting____
Not enough
rest breaks ____
Other____
Do workers often appear exhausted at the end of the day?
Yes____ No____
Solutions
What jobs on site are the most hazardous for musculoskeletal injuries?
Most hazardous jobs for musculoskeletal injuries
What has been done to get worker ideas to help reduce musculoskeletal injuries on the job?
What can be done working together to reduce these injuries?
What can be done to reduce the hazards or make the jobs easier?
Proposed
solutions
Most effective
Easiest to implement
Least expensive
1.
1.
1.
2.
2.
2.
3.
3.
3.
4.
4.
4.
5.
5.
5.
Least effective
Hardest to implement
Most expensive
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What heavy materials or equipment are being handled on site — drywall, rebar, concrete forms, anything over 20 pounds?
What jobs require workers to stand all day, especially on concrete floors?
What jobs require sitting all day?
