Musculoskeletal Risk Assessment Form
Assess musculoskeletal risk factors related to your work or task. Please provide accurate details to help identify and manage potential risks.
Your job title and department
*
Briefly describe the primary task or activity being assessed
*
How often and for how long is this task performed?
*
Occasionally (less than 1 hour/day)
Frequently (1–4 hours/day)
Continuously (more than 4 hours/day)
Indicate the level of risk for the following factors
*
Rows
Low
Moderate
High
Repetitive motions
1
2
3
Force or load handling
4
5
6
Awkward or sustained postures
7
8
9
Use of vibrating tools/equipment
10
11
12
Exposure to environmental factors (cold, wet, noise, etc.)
13
14
15
How would you rate the overall risk of musculoskeletal injury for this task?
*
1
2
3
4
5
How often do you experience discomfort or fatigue during/after this task?
*
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
Are there any controls or measures currently in place to reduce risk?
*
Yes
No
Not sure
Please describe any tools, equipment, or machinery used during the task
What recommendations do you have for reducing musculoskeletal risk in this task?
Additional comments or observations
Submit Assessment
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