LAC 28:CXXXIII.3111. Evaluation

A. Physical Stress 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 B. Force 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 C. Posture 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 D. Workstation 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 E. Repetitiveness 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 F. Tool Design 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 G. Work Environment 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 H. Computer Work Stations 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