Asking employees about their health is one component of an efficient ergonomics program for WMSD prevention. Finding out whether employees are suffering any discomfort, pain, or handicap that may be related to work-related tasks is made easier with the use of a symptoms survey.
Health survey example
1. What is your present position's name?
What are your main responsibilities at work?
3. How long have you been handling these responsibilities?
4. What is your primary working or body position?
5. What equipment do you use most frequently?
6. Do you frequently need to reach outside of your body?
7. Do you frequently use equipment or objects that are above shoulder height or close to the ground?
8. Do you engage in repetitive motions?
9. Which of the tasks you complete do you find the most challenging?
10. Have there been any recent changes to your employment, your tasks, or your tools?
11.
The body parts are approximated in this diagram. If you are experiencing any pain or discomfort, kindly describe where it is. Any area(s) where you experienced work-related pain or discomfort that lasted at least two days in the past year should have some shade. Go to question #46 if you did not shade in any areas.
kind of pain
5. Have you ever experienced work-related pain or discomfort that lasted for two days or longer?
A) Neck Yes No
Shoulder Yes No C) Elbow Yes No D) Wrist/forearm Yes No d) Hand Yes No e) Upper back Yes No f) Lower back Yes No (Yes No h) Foot Yes No Go to question #46 if """"no"""" was your response to each of the preceding questions. Please respond to the following questions for the specific body part(s) for which you selected """"yes"""" to any of the statements in brackets a through h above. a sore neck
6. Is there any discomfort or pain while working? Less Worse Same
7. Is there any soreness or suffering following your shift? Less Worse Same
8. Is there any soreness or discomfort following a week off of work? Less Worse Same
9. Have you missed work in the last year as a result of pain or discomfort? Yes No If so, how many vacation days total? ____ days
10. Over the past year, how much has your pain or discomfort affected your ability to work, live your life outside of work, and sleep?
1) To what extent does it obstruct your work? No disruption Some disruption Pain forced me to take time off of work. How many days off did you take last year if you had to miss work? 2) To what extent does it impede your personal life? No disruption Some disruption Pain forced me to quit enjoying activities. How many days in the last year did you have to stop your activity because you had to? 3) To what extent does it disrupt your sleep? No disruption Some disruption It affects me every night
Shoulder pain
11. While working is the pain or discomfort: Less Worse Same
12. After your shift, is the pain or discomfort: Less Worse Same
13. After a week away from work, is the pain or discomfort: Less Worse Same
14. Has the pain or discomfort caused you to take time off work in the past year? Yes No If so, how many vacation days total? _____ days
15. To what degree has your pain or discomfort interfered with your work, your life outside of work, and your sleep in the past year?
1) How much does it interfere with your work? No interference Some interference Had to take time off work due to pain If you had to take time off work, how many days off in the past year? _____ 2) How much does it interfere with your life outside of work? No interference Some interference Had to stop enjoying activities due to pain If you had to stop activities, how many days in the past year did you stop it? _____ 3) How much does it interfere with your sleep? No interference Some interference It affects me every night
Elbow pain
16. While working is the pain or discomfort: Less Same Worse
17. After your shift, is the pain or discomfort: Less Same Worse
18. After a week away from work, is the pain or discomfort: Less Same Worse
19. Has the pain or discomfort caused you to take time off work in the past year? Yes No If yes, how many days off in all? _____ days
20. To what degree has your pain or discomfort interfered with your work, your life outside of work, and your sleep in the past year?
1) How much does if interfere with your work? No interference Some interference Had to take time off work due to pain If you had to take time off work, how many days off in the past year? _____ 2) How much does it interfere with your life outside of work? No interference Some interference Had to stop enjoying activities due to pain If you had to stop activities, how many days in the past year did you stop it? _____ 3) How much does it interfere with your sleep? No interference Some interference It affects me every night
Wrist/forearm pain
21. While working is the pain or discomfort: Less Same Worse
22. After your shift, is the pain or discomfort: Less Same Worse
23. After a week away from work, is the pain or discomfort: Less Same Worse
24. Has the pain or discomfort caused you to take time off work in the past year? Yes No If yes, how many days off in all? _____ days
25. To what degree has your pain or discomfort interfered with your work, your life outside of work, and your sleep in the past year?
1) How much does if interfere with your work? No interference Some interference Had to take time off work due to pain If you had to take time off work, how many days off in the past year? _____ 2) How much does it interfere with your life outside of work? No interference Some interference Had to stop enjoying activities due to pain If you had to stop activities, how many days in the past year did you stop it? _____ 3) How much does it interfere with your sleep? No interference Some interference It affects me every night
Hand pain
26. While working is the pain or discomfort: Less Same Worse
27. After your shift, is the pain or discomfort: Less Same Worse
28. After a week away from work, is the pain or discomfort: Less Same Worse
29. Has the pain or discomfort caused you to take time off work in the past year? Yes No If yes, how many days off in all? _____ days
30. To what degree has your pain or discomfort interfered with your work, your life outside of work, and your sleep in the past year?
1) How much does if interfere with your work? No interference Some interference Had to take time off work due to pain If you had to take time off work, how many days off in the past year? _____ 2) How much does it interfere with your life outside of work? No interference Some interference Had to stop enjoying activities due to pain If you had to stop activities, how many days in the past year did you stop it? _____ 3) How much does it interfere with your sleep? No interference Some interference It affects me every night
Upper back pain
31. While working is the pain or discomfort: Less Same Worse
32. After your shift, is the pain or discomfort: Less Same Worse
33. After a week away from work, is the pain or discomfort: Less Same Worse
34.
Has the pain or discomfort caused you to take time off work in the past year? Yes No If yes, how many days off in all? _____ days
35. To what degree has your pain or discomfort interfered with your work, your life outside of work, and your sleep in the past year?
1) How much does if interfere with your work? No interference Some interference Had to take time off work due to pain If you had to take time off work, how many days off in the past year? _____ 2) How much does it interfere with your life outside of work? No interference Some interference Had to stop enjoying activities due to pain If you had to stop activities, how many days in the past year did you stop it? _____ 3) How much does it interfere with your sleep? No interference Some interference It affects me every night
Lower back pain
36. While working, is the pain or discomfort: Less Same Worse
37. After your shift, is the pain or discomfort: Less Same Worse
38. After a week away from work, is the pain or discomfort: Less Same Worse
39. Has the pain or discomfort caused you to take time off work in the past year? Yes No If yes, how many days off in all? _____ days
40. To what degree has your pain or discomfort interfered with your work, your life outside of work, and your sleep in the past year?
1) How much does if interfere with your work? No interference Some interference Had to take time off work due to pain If you had to take time off work, how many days off in the past year? _____ 2) How much does it interfere with your life outside of work? No interference Some interference Had to stop enjoying activities due to pain If you had to stop activities, how many days in the past year did you stop it? _____ 3) How much does it interfere with your sleep? No interference Some interference It affects me every night
Foot pain
41. While working is the pain or discomfort: Less Same Worse
42. After your shift, is the pain or discomfort: Less Same Worse
43. After a week away from work, is the pain or discomfort: Less Same Worse
44. Has the pain or discomfort caused you to take time off work in the past year? Yes No If yes, how many days off in all? _____ days
45. To what degree has your pain or discomfort interfered with your work, your life outside of work, and your sleep in the past year?
1) How much does if interfere with your work? No interference Some interference Had to take time off work due to pain If you had to take time off work, how many days off in the past year? _____ 2) How much does it interfere with your life outside of work? No interference Some interference Had to stop enjoying activities due to pain If you had to stop activities, how many days in the past year did you stop it? _____ 3) How much does it interfere with your sleep? No interference Some interference It affects me every night
Other health problems
46. Do you experience any other health problems related to your work? Yes No If yes, please describe:""" - https://www.affordablecebu.com/
