Musculoskeletal Disorders (MSD) Risk Assessment Form
Assess work-related musculoskeletal risk factors, discomfort, and current controls using a concise, modern screening form.
Work and Task Profile
Job role or department
*
Primary work area or work environment
*
Please Select
Office
Warehouse
Manufacturing floor
Healthcare setting
Retail store
Field work site
Vehicle/Driving route
Laboratory
Other
Main tasks performed most often
*
Computer/desk work
Standing at a counter or station
Lifting/carrying materials or supplies
Repetitive hand or arm work
Pushing/pulling carts or equipment
Patient/customer handling or assisting
Operating tools or machinery
Driving or operating a vehicle
Walking/stocking/inspection rounds
Other
Load Handling Details
Typical Load Weight - Minimum (kg)
*
Typical Load Weight - Maximum (kg)
*
Load Handling Mode
*
Handled alone
With assistance
Both
Varies by task
Workstation and Tool Setup
Is the workstation adjustable?
*
Yes
No
Partially
Not sure
Are the tools/equipment ergonomically suitable?
Symptoms and Discomfort
Level of work-related discomfort by body area
*
Rows
No discomfort
Mild
Moderate
Severe
Very severe
Neck
1
2
3
4
5
Shoulders
6
7
8
9
10
Upper back
11
12
13
14
15
Lower back
16
17
18
19
20
Elbows
21
22
23
24
25
Wrists/Hands
26
27
28
29
30
Hips/Thighs
31
32
33
34
35
Knees
36
37
38
39
40
Feet/Ankles
41
42
43
44
45
Other body area of concern
Control Measures and Follow-up
Received training on safe lifting or workstation setup?
*
Yes
No
Not sure
Are breaks or task rotation available?
*
Yes
No
Not sure
Overall risk rating / priority for follow-up
*
Low priority
1
2
3
4
5
6
7
8
9
High priority
10
1 is Low priority, 10 is High priority
Additional comments or work-related concerns
Submit Assessment
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