Purpose The purpose of this safety program is to aid business owners in effectively managing their ergonomic risk. Each business is unique and each program will require customization. As the program is customized, remember to only include words, sections, concepts, procedures, etc. that are relevant to the operations. The purpose of any written safety program is to provide a clear and consistent plan for addressing safety in a particular area of focus. Use Use this wizard to customize your program. Instructions To develop your customized plan, follow steps 1 through 3 in order, by clicking the buttons and following the instructions prompted by the program. Customize Review and Format Approve & Save

<CompanyName>

Ergonomics Program

Version <Version>

Updated: <Date>

Contents

1.	Program Purpose	3

2.	Responsibilities	3

3.	Task/Workstation Evaluations	3

4.	Medical Management	4

5.	Training	4

Appendix I – Office Ergonomics Evaluation Form	5

Appendix II – Industrial Ergonomics Evaluation Tool	6

Appendix III – Manual Material Handling Evaluation	7

Employee Acknowledgement	8

Program Purpose

The purpose of <CompanyName>’s ergonomics program is to provide a consistent approach to managing the risk of musculoskeletal disorders in the workplace. Musculoskeletal disorders (MSDs) are cumulative trauma injuries developed by repeated or sustained exposure to ergonomic risk factors over time. In a practical sense, ergonomics is all about ensuring the demands of a task don’t exceed a workers’ capability to carry it out safely. <CompanyName> is committed to identifying ergonomic risk factors and implementing controls to reduce the risk of injury.

Responsibilities

<OwnerRole> is responsible for reviewing and updating of the program annually or when significant changes in operations occur.

<EvaluatorLeadRole> is responsible for selecting, training and maintaining a sufficient number of ergonomic evaluators to support the needs of the organization; and ensuring routine and non-routine evaluations are completed per the program requirements.

<ImplementationRole> is responsible for reviewing completed evaluations and implementing recommendations where feasible.

<TrainingRole1> is responsible for assuring employees are trained upon hire.

<TrainingRole2> is responsible for assuring employees are trained upon job transfer, addition of new workstation equipment, or after significant changes in operation.

All employees are responsible for participating in required training and the reporting of musculoskeletal disorder symptoms at onset.

Task/Workstation Evaluations

The purpose of ergonomic evaluations is to identify MSD risk factors, and opportunities to eliminate or reduce worker exposure to them. Tasks and workstations will be evaluated using the following assessment forms:

Office Ergonomic Evaluation Form (Appendix I)

Industrial Ergonomics Evaluation Tool (Appendix II)

Manual Material Handling Evaluation (Appendix III)

An initial assessment of non-office work tasks has been completed using the Industrial Ergonomic Evaluation form (Appendix II) and/or Manual Material Handling Evaluation form (Appendix III) where applicable. Tasks will be reassessed <ReassessmentFrequency>; and whenever new tools, workstation equipment, or processes are introduced to the work environment.

The evaluation process will result in the identification of ergonomic risk factors for injury and recommendations for eliminating or reducing worker exposure to risk factors. Recommendations will be reviewed and implemented where feasible.

Evaluations will be conducted for employees reporting discomfort, or the symptoms of a developing or established MSD. Examples include pain, numbness, tingling and reduced range of motion. Employees without symptoms who would like an evaluation are also encouraged to request one. Requests should be directed to <EvaluatorLeadRole>.

Prior to the purchase or introduction of new tools, workstation equipment, or processes; personnel will be required to work with <NewToolEvaluator> to evaluate the potential impact on exposure to ergonomic risk factors.

Medical Management

All employees are encouraged to immediately report any symptoms of discomfort that may be associated with their job duties. Ergonomic evaluations may be conducted to identify and reduce exposure to risk factors, and as needed, employees may be sent for medical evaluation and treatment. Efforts will be made to provide injured workers with temporary transitional duty to accommodate any work restrictions prescribed by a doctor.

Training

New employees shall be trained on the organization’s ergonomics program. Training will include the following elements:

How to recognize risk factors for musculoskeletal disorders and strategies for reducing exposure to those risk factors.

Signs and symptoms of work-related musculoskeletal disorders, the importance of early reporting, and medical management procedures.

Reporting procedures and the person to whom the employee is to report workplace risk factors; and symptoms of a developing or established injury.

Process the organization has adopted to identify and control workplace risk factors, each employee’s role in the process, and how to participate in the process.

As applicable, job-specific training on how to adjust workstation equipment so that exposure to risk factors is minimized.

Refresher training will be provided <TrainingFrequency>.

Appendix I – Office Ergonomics Evaluation Form

Employee Name:	Date:
Evaluator: <NewToolEvaluator>	Employee reporting pain or discomfort?:

Y/N	COMMENTS	RECOMMENDATION
Chair
Does chair properly support the lower back?
Does the seat pan properly support this person? Is it too large or too small?
When chair is properly adjusted, are feet placed flat on supporting surface?
Are armrests adjusted such that they do not obstruct the worker from getting up close to the desk?
Is there ample space under the work surface for legs and knees?
Keyboard and Mouse
Is keyboard aligned with monitor?
Is keyboard at, or just below, resting elbow height?/Are arms at 90 degrees when using the keyboard?
Are wrists straight while using the mouse/keyboard?
Are wrists or arms free from contact stress?
Are shoulders relaxed and not elevated when working at work surface?
Is the mouse at the same level as the keyboard?
Monitors
Monitor distance allows employee to read screen without leaning head, neck or trunk forward/backward.
Top line of screen is at or below eye level so employee is able to read without bending head or neck down/back.
Monitor is placed directly in front of the worker. Dual monitors are situated to minimize twisting of the neck.
Is monitor protected from excessive glare?
Does employee wear progressive lens eyewear? If yes, monitor may need to be lowered.
Accessories
If documents are frequently referenced, are they displayed to avoid excessive twisting or bending?
If employee uses the phone frequently, would a wireless headset or Bluetooth help to minimize neck strain?
Are frequently used items (i.e. mouse, calculator, telephone) placed within 10-16 inches of reach?

Appendix II – Industrial Ergonomics Evaluation Tool

SEE ADDITIONAL ATTACHMENT IN SAFETY ONDEMAND

Appendix III – Manual Material Handling Evaluation

SEE ADDITIONAL ATTACHMENT IN SAFETY ONDEMAND

Employee Acknowledgement

I have received information on <CompanyName>’s Ergonomics Program. By signing below, I agree to abide by the procedures in this document and bring to the attention of my supervisor any questions or concerns had.

Employee Name:
Employee Signature:
Date:

icwgroup.com ICW Group is the marketing name for ICW Group Holdings, Inc. For a list of all ICW Group Holdings, Inc. subsidiaries, please visit our website www.icwgroup.com.
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