Remote Work Ergonomics Home Setup Assessment

Remote Work Ergonomics Home Setup Assessment — Form Fields

This surveys template includes 9 fields. Assess employee home office ergonomic setups for remote work wellness programs. Free to customize and use on ZenBuild.

• Work Email (email, required)
• Primary Work Surface (dropdown selection, required) — options: Dedicated Desk, Kitchen Table, Couch/Lap, Adjustable Standing Desk, Other
• Chair Type (dropdown selection, required) — options: Ergonomic Office Chair, Standard Chair, Stool, Couch, Floor Cushion
• Monitor at Eye Level? (multiple choice, required) — options: Yes, No
• External Keyboard and Mouse Used? (multiple choice, required) — options: Yes, No
• Hours per Day at Computer (number, required)
• Physical Discomfort Experienced (checkboxes, optional) — options: Neck Pain, Back Pain, Wrist Pain, Eye Strain, Headaches, None
• Overall Ergonomic Setup Quality (rating, required)
• Additional Equipment Needed? (long text, optional)