Ergonomic Office Equipment | Back Care Solutions

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Location
incl. dept. & full address

Height
Feet & Inches

% of day at computer

% on other activities

Do you use a footrest?

Yes

Any allergies?

Yes

List allergies here:

Floor Surface

Soft carpet

Carpet tile

Vinyl

Wood

Tile

Concrete

Other:

Arm rests required?

Yes

Neck rest required?

Yes

Would memory foam be beneficial?

Yes

Preferred back rest height
(if applicable)

Below shoulder blades

On shoulder blades

Above shoulder blades

A. Width between elbows (cm)

B. Hip width when in a sitting position (cm)

C. Height from top of shoulder to surface of seat (cm)

D. Height from centre of lumbar curve to surface of seat (cm)

E. Height from underside of elbow to surface of seat (cm)

F. Depth from back of buttock to back of knee joint (cm)

G. Height from back of knee to floor, wearing shoe (cm)

Diagnosed medical conditions

POSE™ Personal Office Seating Evaluation