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Ergonomic Risk Assessment
Job or Task: _________________________________ Date: _____________________
Completed by: _______________________________
Once a potential risk of repetitive strain injury (RSI) has been identified, the purpose of this risk
assessment is to determine if a high risk of injury exists. We recommend that it be completed by
someone who understands the work process, the risk factors that contribute to a RSI, and the principles
of risk assessment and control.
Instructions:
1. Write in the job title or task, date and name of person(s) completing this Ergonomic Risk
Assessment above.
2. Observe and consult with a representative sample of workers and those workers with signs and
symptoms of RSI who perform the specific job task.
3. Read across the page under each risk factor and determine if all of the conditions in that row are
present in the work activities.
Note Duration:
– Duration (e.g., 2 hours total per day) refers to the total time per day the worker is exposed to the
risk factor(s), not the duration of the work activity that includes the risk factor(s).
– However, when duration is associated with repetition (e.g., using the same motion every few
seconds) or frequency (e.g., more than once per minute), it refers to duration per day of the
repetitious task.
– If exposure to a risk factor (e.g., 2 hours total per day) is continuous, the risk will be significantly
greater than intermittent exposure distributed over a shift.
4. Check the box (þ) to indicate that a “high” risk of RSI injury exists if all conditions are present.
Make any appropriate notes to clarify specific details.
5. Complete the Risk Factor Summary Table below.
6. A “high” risk task requires that controls be implemented without delay. Controls should eliminate, or
if that is not practicable, minimize t
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