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Body Map
Ask your workers to describe how Neckdifferent parts of their bodies feel. Using Lf ihthe numbers 0 to 4, write what they tel Shoulder Soleyou in the circles.
Department_____________ Let'ight
Job________________
Your name________________Back Lower
Survey date_______________
Survey time__________________
Left Rig ht
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Department Your Name_ _______
Job Date
Worker's Name Time
Check the box if you see the worker doing any of these movements or positions. Check as many asyou see.
E Bending or turning the wrist in any direction 9
"[ Reaching forward with one or both armsstretched out
" Reaching to the side with one or both arms
stretched out
"E Reaching behind
"E] Raising elbows away from the body A
"C- Turning the lower arm between palm up andpalm down
(see other side)
LI Pinching, pulling, or using force
LI Hunching the back
LI Bending the neck
LI Pressing hands or arms on sharp edges
LI Twisting and bending
If you checked any of the boxes, the worker may be at risk, especially if the movement or positionhappens often or for long periods.
Some other things to look for:
LI Using home-made aids or tools
LI Using wrist or finger wraps
LI Using pillows
LI Signs of fatigue, such as slumping, rubbing neck or hands, sighing, shifting positions
LI Tool or equipment that vibrates too much
LI Anything else you notice (write here or attach another page)
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