Study of the Ergonomic Status of the Cashiers Office

at Chippewa Valley Technical College

by

Robert Holveck

A Research Paper Submitted in Partial Fulfillment of the

Requirements for the Master of Science Degree

m

Risk Control

Approved: Three Semester Credits Digitally signed by Bryan Beamer

B rya n B e a m e r ON: cn=Brya~ Beamer, o=University of Wisconsin-Stout, ou=MS Risk Control, emall=beamerb@uwstout.edu,c=US Date: 2011.09.07 09:20:55 -05'00'

Bryan Beamer, PhD, PE, CSP

The Graduate School

University of Wisconsin-Stout

August, 2011

1

2

The Graduate SchoolUniversity of Wisconsin-Stout

Menomonie, WI

Author: Holveck, Robert C.

Title: Study of the Ergonomic Status of the Cashiers Office

at Chippewa Valley Technical College

Graduate Degree/ Major: MS Risk Control

Research Adviser: Bryan Beamer, Ph.D.

Month/Year: August, 2011

Number of Pages: 41

Style Manual Used: American Psychological Association, 6th edition

Abstract

The Chippewa Valley Technical College cashiers office was experiencing employee

injuries and discomfort due to human factors considerations. The purpose of the study was to

conduct an ergonomic analysis of the current workplace. Through the use of worker surveys,

assessment tools, and physical measurements, it is suggested that the college make both

engineering and administrative changes. This involves incorporating fully adjustable workspace

furniture in all stations and implementing an ergonomic program into the school's management

system that includes stretching and job rotation.

3

The Graduate SchoolUniversity of Wisconsin Stout

Menomonie, WI

Acknowledgments

This study could not be done without the cooperation and assistance of the staff at

Chippewa Valley Community College. The author would also like to acknowledge the

professors and advisors at the University of Wisconsin-Stout Risk Control program. As well,

many thanks to my family for their support and encouragement.

4

Table of Contents

...................................................................................................................................................Page

Abstract............................................................................................................................................2

List of Tables....................................................................................................................................6

List of Figures..................................................................................................................................7

Chapter I: Introduction....................................................................................................................8

Statement of the Problem.....................................................................................................9

Purpose of the Study............................................................................................................9

Assumptions of the Study....................................................................................................9

Definition of Terms..............................................................................................................9

Methodology......................................................................................................................10

Chapter II: Literature Review........................................................................................................11

Chapter III: Methodology..............................................................................................................21

Subject Selection and Description.....................................................................................21

Instrumentation..................................................................................................................22

Data Collection Procedures................................................................................................23

Chapter IV: Results........................................................................................................................25

Item Analysis....................................................................................................................25

Limitations........................................................................................................................29

Chapter V: Discussion....................................................................................................................30

Conclusions........................................................................................................................30

Recommendations..............................................................................................................30

5

References......................................................................................................................................33

Appendix A: Sample Empty Survey..............................................................................................37

Appendix B: Summary of Completed Surveys..............................................................................39

Appendix C: Sample Blank RULA ...............................................................................................40

Appendix D: Completed RULA ....................................................................................................41

6

List of Tables

Table 1: Supervisor Desk…………..…………………………………………27

Table 2: Empty Cashier Desk……………………..…………………………28

Table 3: Faculty Desk…………..……………………………………………28

7

List of Figures

Figure 1: Carpal Tunnel Syndrome………………………………………………..……15

Figure 2: Thoracic Outlet Syndrome………………………………….……..….………16

Figure 3: Carpel Tunnel Release Surgery………………………….……………………20

8

Chapter I: Introduction

Located in Eau Claire, WI and surrounding areas, Chippewa Valley Technical College

(CVTC) has a staff of over 400 and serves nearly 6,000 students. The cashiers department of the

school processes all tuition and other financial fees of its clients. As reported by the supervisor

of the cashiers office, an employee in this position spends 90% of the time sitting in front of a

computer in a typical office setting. Numerous faculty members in the cashiers office of the

Chippewa Valley Technical College campus identified pain and discomfort in the upper and

lower back areas. As well, neck, shoulder, and arm strain have been mentioned by the office

staff. Although no workers compensation has been collected by any worker, the pain and

discomfort suffered by these victims has led to unnecessary time away from work, productivity

loss, lower quality output, and decreased employee morale. While, it is difficult to pinpoint an

exact monetary loss to the college, this ergonomic issue (and ones similar to it throughout the

campus) costs the school thousands of dollars a year.

Significance

Although this study focused on ergonomic issues at a local technical college, poor human

factor designs are a nationwide problem. According to the Burden of Musculoskeletal Diseases

(BMD) in the United States organization (2008), more than one in four Americans has a

musculoskeletal condition requiring medical attention. BMD also estimates that these disorders

cost the United States around $849 billion a year. These figures did not even include

productivity declines due to unreported pain and discomfort suffered by victims of MSD's. In

certain industries, the cost is even greater. In his article, Kobe (1998) concludes that, in the field

of auto manufacturing, an ergonomic injury costs a company an average of $27,000 a day. It is

9

easy to see what the cost of musculoskeletal disorders is incurring onto our country. If this issue

is not addressed, the problem will only get worse.

Statement of the Problem

Chippewa Valley Technical College has an unacceptable rate of musculoskeletal injuries.

Without addressing this issue, the number of employees reporting ergonomically related

disorders will continue to rise. The study focused on pain and discomfort incurred by employees

to the neck, shoulder, back, and wrists among three different workspaces. These included the

supervisor's office, cashiers desk, and faculty cubicle. The analysis was conducted while

employees performed routine office activities.

Purpose of the Study

The study was designed to perform an ergonomic study to identify, measure, and provide

recommendations to eliminate or reduce the ergonomic defects in the workplace at CVTC that

have led to employee injuries.

Assumptions of the Study

The study assumed that all subjects were of normal health. All work completed by

employees while being studied was typical workload.

Definition of Terms

Ergonomics - The study of designing a workplace to the fit the user.

RULA (Rapid Upper Limb Assessment) - An evaluation tools utilized to determine the

ergonomic risk involved in an observed activity. A RULA also helps the user decide

whether further investigation/action should be taken to limit the employer's exposure

to potential injury caused by the activity.

10

Limitations of the Study

Employees were not observed on a continuous basis. The responses to all surveys

received by workers was truthful and honest. As well, the research focused on back, neck,

shoulder, and wrist disorders at CVTC. Therefore, the findings of the paper was restricted to

these parameters.

Methodology

Surveys provided to subjects afforded them an opportunity to identify various physical

injuries suffered and discuss areas of ergonomic concern within the workplace. Employees were

also observed on a one-on-one basis in their work environment. As they were being monitored,

ergonomic measurements were gathered including body positions, angles of equipment, and

lighting settings. The characteristics and limitations of current office furniture was also noted.

The questionnaire and quantification results were utilized to determine conclusions and

recommendations for improvement.

Three office spaces were also evaluated. Included in these assessments were physical

measurements of the desk, monitor, keyboard, and footrests. Heights, angles, and distances from

users were also calculated. Finally, a RULA analysis was completed on the Supervisor's station.

11

Chapter II: Literature Review

Ergonomics is concerned with five areas in a task, posture, repetition, duration, force, and

temperature extremes (B. Finder, personal communication, September, 2010). Posture is defined

as the position(s) of all affected body parts during the entire cycle of a motion. Repetition can be

determined by calculating how often the movement is performed within a given period of time.

In most cases, this will be an hourly or shift computation. Duration is simply how long the

person is required to execute the motion(s). This is oftentimes the length of the workers shift.

Force looks at the amount of pressure placed on the joint or body part. The final aspect of

ergonomics, temperature extremes, accounts for any drastic temperatures endured by the

employee as they carry out the movements. Radical change in temperature is also examined. All

of these factors combine determine the overall ergonomic risk of a task.

Ergonomics HistoryFormed by the combination of the words ergos (work) and nomos (natural laws),

ergonomics is the science of matching a person's environment to the individual (Murrell, 1958).

Originally coined by Wojciech Jastrzebowski in 1857, the study of ergonomics includes an

understanding of human capabilities and limitations, and how to best fit equipment, machines,

and processes into these human laws (Osborne, 1987).

The roots of ergonomics can be found in ancient cultures. Findings indicate that early

greek civilizations utilized ergonomic principles in the design of tools and workspaces.

Although not officially defined as ergonomics, early man knew the importance of matching a

tool to the person. By accomplishing this, work was completed more effectively and efficiency

(Osborne, 1987).

12

The Industrial Revolution thrusted ergonomics into the limelight. As Rochelle Gainer

(2008) describes it, in the 1760's, people abandoned the physical labor of farming and

agriculture, and began working in factories. In these environments, workers oftentimes

performed repetitive movements in unnatural postures. This led to a rash of new injuries never

before seen.

Although the use of ergonomic principles have been traced as far back as the 5th century

BCE, the science of ergonomics as we currently know it began on 12 July 1949. It was at this

time that a meeting was held at the British Admiralty at which an interdisciplinary group formed

to address human work problems (Osborne 1987).

Recently, the field of ergonomics has experienced a boom. As more employers and

business firms begin to understand the power and importance utilizing an ergonomically sound

workplace, there has been more and more research done on the subject. Because industry has

witnessed a decrease in injury rates and worker compensation claims after implementing an

ergonomic program, the science has expanded rapidly and become more accepted by the public.

One area where were ergonomics has had a tremendous impact is automation. As Standon and

Stammers (2008) attest, the past half century has seen automation enter into all aspects of our

working, social and domestic lives. What is the cause of this shift? After conducting human

factor analysis on numerous job tasks, employers are coming to the realization that it is more

efficient, cost effective, and safer to automate a process than have a person carry out the exercise.

In the past, a business would not have even thought of using robots, but now, because of a

expansion in the acceptance of ergonomics, they have become common place.

13

The rapid acceptance and reliance on ergonomics has created an exciting future for the

field. As more and more industry understand the power of matching machine to operator, the

more critical ergonomics becomes to the business model.

Although the future of the human factors disciple appears bright, improvements must be

made in the field for it to continue its widespread utilization. Brewer and Hsiang (2002) point

out that ergonomics must create a more uniform and easily understood system for presenting

models, theories and conclusions to those responsible for the safety and wellbeing of workers.

Brewer and Hsiang also assert that if ergonomics is to maintain its momentum, those in the field

must continue to work with other disciplines such as economics, sociology, and psychology. If

ergonomist can meet these challenges, the human factors domain will continue to have a

prominent place amongst decision makers in business and industry.

Ergonomic Injuries

Brewer (2002) defines ergonomics as the effort made to match a user’s capabilities with

the system requirements. If these capacity considerations are ignored, musculoskeletal injury to

the operator can occur. This may include neck and back strains, as well as tendonitis and carpal

tunnel. One of the primary roles of ergonomics is the prevention of these work-related

musculoskeletal disorders (MSDs). This is accomplished by matching workers and workplaces

in a manner that improves worker productivity while decreasing the worker’s risk of injury and

discomfort (Boudreau, 2003). Unfortunately, MSDs are fairly common in the workplace.

According to a study conducted by Gerr, Ensor, Kleinbaum, and Edwards (2002) among 416

U.S. employees, 63% reported neck pain and 34% disclosed arm or hand discomfort. Although

prevalent, the vast majority of work-related ergonomic incidents can be reduced or even

14

eliminated. The first step in preventing MSDs is to understand their sources and symptoms.

Strains on the neck or back are caused when the muscles, tendons, and ligaments in these areas

are overexerted. This can result from repetition, overloading, or awkward positions. These are

typically triggered by overuse, such as too many hours hunched over a desk or computer.

Muscles, fatigue and become strained. If the overuse occurs repeatedly, the result can be chronic

pain (Mayo Clinic, 2009). A person suffering from neck or back strains may exhibit any or all of

the following symptoms:

- Burning or tingling sensation

- Inflammation

- extremities (fingers or toes) turning white

- Shooting or stabbing pain

According the American Medical Association (2006), an individual afflicted with a strain may

report pain, swelling, numbness, muscle spasms and/or loss of function or strength in the area

directly affected. In the case of a neck strain, headaches may also be present.

Another musculoskeletal disorder is tendonitis. Tendons are ribbons that connect muscle

to bone. As Susan Orr (2007) describes, tendonitis is an inflammation or irritation of one or

more of these tendons, which is caused by overuse or injury. The condition may also involve the

swelling of tendon sheathes (casings that cover a tendon). This thickening can restrict the

movement of a tendon causing pain and discomfort.

In the human body, there is a tunnel in the wrist in which nerves and blood vessels travel

though. The Merck Manual Home Health Handbook describes the disorder known as carpal

tunnel syndrome as a painful compression of the median nerve as it passes through this tunnel

(Porter, 2009)(fig. 1). Orr(2007) elaborates on this condition, stating

15

Initial complaints are usually about feeling tingling or burning in the fingers and hands, and people often talk about having dull or aching discomfort or pain. As the problem gets worse there is shooting pain, often up the arm, and less movement in the fingers, hands, elbows or shoulders. Next there is less hand strength and perhaps numbness which can result in the dropping of objects. As carpal tunnel gets more serious, there is difficulty sleeping due to the increased pain (p 15).

Fig. 1 Carpal Tunnel Syndrome

Both back and neck strains, and carpal tunnel are of great concern in an office

environment. In this climate, employees may spend upwards of 8 hours executing repetitive

motions in unnatural body postures. As Werner (2006) stated, "Carpal tunnel syndrome is a

common problem in the workplace and there are well-established risk factors such as repetition,

force, and posture that contribute to the high prevalence of CTS in the workplace".

The last musculoskeletal disorder of note is thoracic outlet syndrome (TOS). Occurring

in shoulder area (fig. 2), TOS is a symptom complex caused by compression or irritation of the

neurovascular structures as they leave the thoracic cage through its narrow outlet (Lindgren,

2010). Symptoms of thoracic outlet syndrome include:

- Feeling of heaviness and fatigue in the arm and hand

- Coldness in the hand or fingers

16

- Deep pain in the neck and shoulder region

- Muscle cramps

- Discoloration of the skin

Fig. 2 Thoracic Outlet Syndrome

Numerous studies have been conducted on musculoskeletal disorders in the workplace.

More specifically, a great amount of research has been completed on MSD's in office settings.

While the results vary, a correlation has been made between heavy doses of computer work and

the development of musculoskeletal injuries. This was the conclusion that Gerr (2002) arrived in

his published paper. In his study, Gerr writes that upper-extremity musculoskeletal symptoms

affected more than half of the study participants who use a computer for more than 15 hours a

week in their first year on a new job. Nunes (2009) adds to these findings when she declares that

ergonomics studies have clearly established a relationship between certain occupational activities

and work-related musculoskeletal disorders. Activities such as typing, assembling, or lifting are

associated with exposure to ergonomic risk factors for these injuries.

Assessment Tools

17

Armed with an understanding of the various musculoskeletal disorders that exist and their

ties to the work conditions, it is important to focus on the workstation. When attempting to

create a more ergonomically well designed space, the first step is assessing the current

environment. This includes analyzing the workplace, the demands of the job, and the limitation

of the employee assuming these responsibilities. There are many tools available to evaluate each

area, and the one utilized will determined on a case-by-case basis. Two of the most popular

devices used to identify the ergonomic risks of a job are the Rapid Upper Limb Assessment

(RULA) and the Rapid Entire Body Assessment (REBA). These instruments are quick and easy

ways to qualitatively measure the ergonomic rating of an environment. In both cases, a person

will observe the subject completing a particular task from beginning to end. They will then

answer a set of questions based on what they noticed. The questions involve placing the nature,

degree , and repetition of movements made during the process into numerical values. These

numbers are then added together and a resulting score is attached to the job. This score identifies

the risk involved with the activity, and actions that can be taken to improve the situation. (see

Appendix D).

While similar, RULA and REBA differ slightly in their application. RULA is more often

used for motions of the the arms, shoulders, wrists, or neck. REBA is a more suitable tool for

assessing situations where movement of the legs, torso, lower back, or feet are present (B.

Finder, personal communication, October, 2010). Although RULA and REBA are widely used

and are considered the standard for evaluating the ergonomics of a process, they are not without

their flaws. The results generated by these tools are only as accurate as the information put into

them. If the observer fails to correctly score sections of the REBA or RULA form, the

conclusions drawn will be inadequate and unusable. As well, there is inherent ambiguity and

18

subjectivity with these instruments. When tallying the risks of a task, it is not cut-and-dry. For

instance, while inspecting someone in an office environment, one person may record a pronated

hand of 45 degrees, while another evaluator may only observe a pronation of 25 degrees. These

variances can greatly affect the outcome of the assessment.

While REBA and RULA have their drawbacks, they are so-often utilized for a reason.

Both tools provide simple, use-to-understand recommendations. The results will show either no

action needs to be taken, the process should be improved in the near future, or changes must be

implemented immediately. REBA and RULA assessments also pinpoint the specific activity that

is at the root of the problem. As well, the area of the body affected will be revealed. This

information becomes crucial when taking action to reduce or eliminate injuries. Understanding

what activity and body part is involved will lead to more effective controls.

An ergonomic program can be a profit-making endeavor for a company. From the

medical expenses to the worker's compensation claim, all recordable injuries (incidences

requiring more than first-aid) are costly, and a major accident has the potential to cripple a

company. By lowering the costs of injuries, businesses can increase their overall profitability. In

his article, Eby (1991) illustrates this using a simple example. As he explained,

An ergonomically designed chair can cost as much as $800. If 50 chairs are needed for 50 different workstations, that translates into an outlay of $40,000. While the cost may sound prohibitive, lower back surgery alone costs close to $10,000, and a week of postoperative hospitalization averages $700 per day. If four lower back injuries are eliminated over the 10 years the chairs are in use, the expense is more than justified. Furthermore, a well-designed workplace not only reduces injuries but increases productivity. Because workers are less fatigued and taxed when performing their jobs, their ability to think clearly and produce effectively increases.

Ergonomic Actions and Costs

19

Stress placed on the body can take many forms. These include high repetition, awkward

posture, excessive force, long duration, and temperature extremes. An office setting can put a

person at risk in many of these categories. Repetitive motion, unnatural positions, and lengthy

time periods being the biggest culprits. However, there are many preventative measures that can

be taken to minimize these effects. Engineering the problem out is the most effective method of

reducing or eliminating ergonomic injuries in the workplace. Engineering out the problem

simply means to remove the equipment or process that is causing or potentially causing a

negative desired consequence. For instance, in a case of an office setting, if a person can

complete the job without the need of a desktop computer, the company can simply choose to rid

itself of the machine and use another method that does not pose the same health risks to workers.

If an engineering control is not available or feasible, the second technique for reducing

office ergonomic injuries is to utilize a administrative approach. This involves decreasing the

person's exposure to the hazard through policy changes, job rotation, or employee training. A

business utilizing an administrative strategy may decide to have a office employee work at a

computer station for two hour shift, switch to a completely different task for two hours, and then

return to the office for another two hours. This is job rotation. With this technique, the worker is

not as exposed to the hazards of computer-related musculoskeletal disorders.

Through the use of engineering and administrative controls, the number and severity of

ergonomic injuries work injuries can be lessened significantly. Unfortunately, thousands of

workers have already suffered from back and neck strain, carpal tunnel syndrome, and thoracic

outlet syndrome. In these cases, physical therapy and surgery are oftentimes recommended.

Surgical procedures vary with the musculoskeletal disorder present. In the case of carpal tunnel

syndrome, the surgeon will open up the wrist and physically cut the transverse carpal ligament

20

that forms the roof of the carpal tunnel to relieve pressure on the median nerve. This is

oftentimes called carpal tunnel release surgery (McCabe, 2002). In cases of shoulder injuries, an

arthroscopic procedure may be undertaken (fig.3).

Fig. 3 Carpel Tunnel Release Surgery

Therapy techniques for common MSDs include strengthening and flexibility exercises,

acupuncture, massage, and chiropractic manipulation (Fried, 1998). Utilizing these methods, a

patient conducts a regular set of prescribed movements of the tendons and ligaments in the

affected area. Heating and cooling of the region can also be present in therapy sessions, and, in

some instances, drug treatment is utilized. These actions may help help restore normal joint

movement, improve circulation, and relieve pain. Although surgery and therapy may help

relieve some discomfort for the patient, it is not guaranteed and costs the company a small

fortune in worker compensation charges. Also, these solutions are very temporary and the

symptoms will return as long as the worker continues to overexert the body. As long as the root

21

cause is present, musculoskeletal injuries will persist. While musculoskeletal disorder treatments

are present, an organization is better served by preventing ergonomic injuries before they begin.

22

Chapter III: Methodology

Chippewa Valley Technical College has had an unacceptable rate of musculoskeletal

injuries. Without addressing this issue, the number of employees reporting ergonomically related

disorders will continue to rise. In order to identify which activities are responsible for these

injuries, an ergonomic assessment was completed. For the purposes of this study, the author

included three tools as part of the evaluation. First, a questionnaire (see Appendix A for a blank

questionnaire) was presented to all employees. This survey garnered subject data such as

physical attributes of the workers, types of injuries experienced, and any treatment that was

conducted. In addition, the researcher conducted an analysis of the workplace. This included

measurements of the furniture and bodily positions of the employees while performing routine

tasks. Finally, a RULA assessment (see Appendix C for blank RULA worksheet) was filled out

by the author.

Subject Selection and Description

The questionnaire was provided to all employees of the cashiers office. Twenty-five

questionnaires were provided to the supervisor to be handed out to each worker. The person then

filled out the survey at their leisure and turned them into the supervisor. Finally, the completed

questionnaires were sent back to the researcher digitally. All employees participating were

scheduled day shifts from 8am to 4pm. The 24 question survey included demographic

information on the subject such as age range, gender, and years worked at the office. The

questionnaire also included inquiries regarding pain and discomfort experienced by the worker to

the neck, back, shoulder, and wrist areas. The employee was asked to rate the level of pain, and

describe any treatment that was performed.

23

Measurements were taken by the author on one of the employees as well. The Supervisor

was observed while performing standard office computer-related tasks including responding to

emails, and deciphering financial spreadsheets. Evaluations conducted by the researcher

involved three main areas. First, physical heights of the workplace were recorded, including the

chair, desk, and computer monitor height. Secondly, measurements of the employees such as

height, general body type, and reach were taken. Thirdly, body angles and positions (including

arms, back, neck, and shoulders) while executing daily activities were documented.

The measurements gathered will be match against standard anthropometric data tables.

These tables are a standardized index of anthropometric statistics whereby, given certain

parameters (such as height and reach of a subject), a person can find the optimum workplace

conditions (including desk and chair height) for that individual. This comparison will determine

the areas of the office space that need attention, and will guide recommendations for future

modifications.

Instrumentation

The survey utilized consisted of 24 questions. A copy of the complete questionnaire can

be seen in appendices A and B. The survey was created by the researcher for the sole purpose of

this study.

There were many instruments employed to gather the anthropometric data for this field

problem. A list of these tools follows.

- Tape measure

- Manual goniometer

- RULA assessment sheet

- Measurement spreadsheet developed by the author to record collected data

24

- Writing utensil

Data Collection Procedures

A 24 question survey was administered by the author to all cashier workers at CVTC.

The questionnaires were then electronically received by the research approximately one week

later. Each measurement utilized for analysis was written down on a specialized log as the

researcher performed the activity.

The measurements collected are displayed pictorially below.

1. Angle of the monitor from 90 degrees.

2. Height of the office chair from the floor to seat.

3. Height of the desk from the floor to the top of the desk.

25

1. Distance from center of keyboard to center of chair.

2. Distance from edge of desk to the center of footrest.

3. Distance from center of monitor to center of office chair.

26

Chapter IV: Results

To analyze the ergonomic status of the cashiers office at CVTC, a survey was given to

four employees and measurements were performed on the workstation including equipment

heights, and body angles of workers.

Item Analysis

Survey

Twenty-four questionnaires (see Appendix A for sample survey) were provided to all

employees of the cashiers office at Chippewa Valley Technical College, and four were returned

(see Appendix B for completed questionnaires). The first section of the survey was demographic

in nature. Questions asked included an age range, gender, and years worked at the office. Of

those who responded, two were in the age parameters of 30-44 and two were 45-59. As well,

three of the employees were female and one was male. Finally, two subjects indicated that they

had worked for CVTC for one to three years, while the other two had been employed by the

college for over ten years.

The second portion of the survey inquired about any pain or discomfort felt by the

employee. The survey-taker was asked to locate the area of the pain and to quantify the intensity

on a scale. First, the workers were asked about any neck pain. Three stated they had

experienced pain or discomfort in the neck area, while only one had not encountered such

sensations. On a scale of 1-10 (ten being highest), the average score of those who had pain was

4. The next question dealt with any back issues. The results were unanimous, all four

respondents declared an occurrence of discomfort in the back. The mean scale average for all

employees was 5.75. The third query involved shoulder pain. As with neck discomfort, three of

27

the four participants stated having pain in the shoulder. This time, the average discomfort

experienced was 5.33 out of 10. Wrist pain was discussed next. For this question, the results

were split down the middle at two apiece. For the two who had wrist injuries, their pain

averaged out to 5.5. The last topic considered pain in the hands and fingers. No survey-takers

expressed any soreness or aches in the palm or digits.

The third segment of the questionnaire involved whether the school was notified of the pain

and whether any treatment that was performed. Three workers disclosed that no injuries or pain

was reported, and one subject did not respond. Also, half of the employees listed at least one

form of treatment performed, while the other two did not undergo any such activities. The types

of treatments listed included massages and chiropractic appointments.

Measurements

Measurements were conducted by the researcher on three workspaces. The first station

was the supervisor's office. The supervisor is assigned the cubicle and is the only employee who

uses it. The results are shown in table 1.

Table 1 - Measurements of the Supervisor's Desk

Supervisor Desk

Equipment Desk Chair Keyboard Monitor Footrest

Height (inches) 27” 21” 26.25” 32”

Angle (degrees) ----- ----- ----- 15 45

Notes

13” from desk edge

Mouse placed on the right side of keyboard. Keyboard had no pull-out tray. Chair was 27” from edge of desk and 24” from monitor.

28

The second workplace examined was an empty cashiers desk. This area is used by several

different cashiers on an irregular schedule. Therefore, the zone is occupied by many individuals.

The data are displayed in table 2.

Table 2- Measurements of Empty Cashiers Desk

For the third analysis, a faculty cubicle was investigated. This space is designated for this staff

member and is utilized only by a single person. See table 3 for details.

Table 3 - Measurements of Faculty Cubicle Workstation

Ergonomic MeasurementsEmpty Cashiers Desk

Equipment Desk Chair Keyboard Monitor Footrest

Height (inches) 28 16 24.13 39

Angle (degrees) ----- ----- ----- 13 45

Notes

20” from desk edge

Mouse placed on the right side of keyboard. Keyboard on tray that pulls out. Chair was 19” from edge of desk and 24” from monitor.

Faculty Cubicle Workstation

Equipment Desk Chair Keyboard Monitor Footrest

Height (inches) 28 20 28.5 42

Angle (degrees) ----- ----- ----- 5 -----

Notes

18” from desk edge

Mouse placed on the right side of keyboard. Employee observed not using provided footrest. When asked, the subject confirmed non-utilization of the rest.

29

Evaluating three separate workplaces provided opportunity to compare each for

similarities and differences. For all three stations, the desk height was almost identical. Also,

every desk had a monitor, keyboard, mouse, and footrest. These items were used regularly by

employees in every case with one exception. In the case of the faculty cubicle, the individual has

chosen not to utilize the footrest.

While a few of the measurements were the same for all stations, in many instances, they

varied greatly. For example, the chair of the empty cashiers area was a full 4 inches shorter than

that of the supervisor and faculty. As well, there was great disparity among the three workspaces

in the position of the computer monitor on the desk. For each place, the monitor height, distance

from chair, and angle differed. This indicates that there is some flexibility and adjustability in

the equipment setup. These differences are expected and indicates that the employees using

them are diverse in size, shape, and preference.

To determine the bodily angles of employees while they were conducting routine

activities at their work station, the researcher measured these angles on the supervisor at her

desk. The results are shown in table 4.

Table 4 - Measurements of Employee

When the measurements gathered were compared to anthropometric tables, the results

were mixed. The seat height for the supervisor's desk was above recommendation. However,

Supervisor Desk

Employee

Neck Shoulder Back Wrists

Angle of body part 5 5 5 8

30

the recorded chair height of the cashiers and faculty cubicle were within guidelines. The

horizontal lengths of the chair seats were a tad long for the majority of both men and women.

Ideally, it should have been one to two inches shorter. The height of all tables measured was

within the 97.5th percentile of the woman population. In all workstations, the placements of the

footrest were within reason.

The data collected on the subject where not surprising and common among people in a

sit-down office job. Although typical, the numbers are not necessarily healthy. Everyone has

their limit for body posture duration and repetition. While the positions alone do not bring up a

red flag, if an employee complains of neck, shoulder, back, or wrist pain the positions could

easily be the culprit.

Limitations

Employees were not observed on a continuous basis. The validity of the paper assumes

that the responses to all surveys received by workers was truthful and honest.

31

Chapter V: Discussion

Chippewa Valley Technical College's cashiers office has experienced numerous employee

injuries related to back, neck, and wrist pain. Of major concern is the chair height of the

supervisor's desk and the length of the seat cushions. To help alleviate this problem, full

adjustability of all furniture including table, computer monitor, keyboard, and chair is a must. As

well, keyboard and mouse supports should be provided.

Conclusions

Through surveys and physical measurements of the office space, the researcher has

concluded that much of the employee discomfort, if not caused by work, is, at least, exacerbated

by the rigors of the job. The author also deduced that most of the pain and discomfort currently

suffered by workers at CVTC can be alleviated by implementing ergonomic principles to the

workplace. These conclusions support past research on work station analysis. Many of the work

areas being used today do not utilize ergonomic science and are, therefore, susceptible to worker

injury and pain.

Recommendations

Upon completion of the study, the researcher recommends changes and additions to the

current setup at CVTC. Many of these alterations involve the physical equipment. To begin, the

desk should be fully adjustable (height, angle, etc.) for every work station. The same

adaptability should be present in all chairs as well. Each keyboard should be a pull-out tray

where the user can change the height and angle of the keyboard. Finally, the researcher suggests

equipping all desks with mouse and keyboard rests. This may help employees who are currently

forced to place their wrist directly on the edge of the desk, cutting off circulation to the hand and

fingers. Following these suggestions will result in a drastically improved station. As a guide, an

32

ideal workplace will have the following characteristics. The desk will be between 25 and 31

inches high. The chair height should be 15 to 18 inches. As well, the seat cushion would have a

length 16 to 20 inches. Because CVTC employs people of both genders, these ranges are large to

encompass the 97.5th percentile of women and men.

While the majority of recommendations revolve around engineering problems out

through adjusting or replacing the physical equipment, there are a few administrative

adjustments that should be addressed. First and foremost, CVTC would benefit from

implementing an ergonomic program. The goal of this measure is to train employees on

ergonomically sound practices such as proper postures, and actions that workers can be taken to

prevent an injury. Instituting a stretching program whereby all employee engage in muscle-

stretching exercises at predetermined intervals may also be included in the program. The

procedure would including finger, wrist, shoulder, and back stretches. The specifics of the

program including exercises completed, duration, and time intervals should be established by the

cashiers office management and staff. It is also the recommendation of the author that frequent

breaks away from the desk (not necessarily breaks from work) should be scheduled. Again, the

details of these recess periods should be decided upon by those who are directly affected. Job

rotation could also be used by the institution. With this program, employees are rotated from job

station to another throughout the day. As an example, a worker could begin at the cashiers desk.

After two hours, they would move to a new responsibility that does not involve sitting at a

computer. The person would resume these duties for another two hours and then switch to

another position unlike the first two jobs for another two hours. By utilizing job rotation, an

employee does not complete the same activities repeatedly.

33

Although it appears that the cashiers office will address their ergonomic risk before major

injury to employees has been reported, it is the belief of the author that CVTC must implement

changed in a timely manner, before costly bodily damage to the workforce occurs.

FUTURE INVESTIGATIONS

After completion of the recommendations described in the previous section, it is

suggested that Chippewa Valley Technical College follow-up on all actions taken. These

investigations should be utilized to determine the effectiveness of the plans implemented as well

as identify areas of further need. It is also in the best interest of CVTC to complete an

ergonomic analysis similar to this one in other departments and buildings within the school, and

introduce changes based on the results found.

34

References

Arthroscopic Shoulder Surgery. Retrieved August 15, 2011, from: URL

(www.orthopedicsurgerybook.com)

Boudreau, L. A., & Wright, G. (2003). Ergonomic considerations for a patient presenting

with a work-related musculoskeletal disorder: a case report. Journal of the

Canadian Chiropractic Association, 47(1), 33-38. Retrieved from EBSCOhost.

Brewer, J. D., & Hsiang, S. M. (2002). The 'ergonomics paradigm': foundations,

challenges and future directions. Theoretical Issues in Ergonomics Science, 3(3),

285-305. doi:10.1080/14639220110114681

Carpal Tunnel Syndrome. (2007). Retrieved August 15, 2011from: URL

(www.chiropractic-help.com)

Eby, R. W., Jr., & Mahone, D. (1991). How to use ergonomics as a loss control tool. Risk

Management, 38(3), 42. Retrieved from

http://search.proquest.com/docview/226977014

Fried, S.M. (1998). Light at the End of the Carpal Tunnel. East Norriton, PA; Healing

Books.

Gainer, R. (2008). History of ergonomics and occupational therapy. Work, 31(1), 5-9.

Retrieved from EBSCOhost.

Gerr F, Marcus M, Ensor C, Kleinbaum D, Cohen S, Edwards A, et al. A prospective study

of computer users: I. Study design and incidence of musculoskeletal symptoms

and disorders. Am J Ind Med. 2002;41:221–35.

35

Kobe, Gerry. (1998). Better Ergonomics Boost Profit and Quality. Automotive Industries.

FindArticles.com. 17 Aug, 2011.

http://findarticles.com/p/articles/mi_m3012/is_n4_v178/ai_20499970/

Lindgren, K. (2010). Thoracic outlet syndrome. International Musculoskeletal Medicine, 32(1), 17-24. doi:10.1179/175361410X12652805807792

Lipsky, Martin S. (2006). Strain. In Concise Medical Encyclopedia (pp. 659). New York, NY; American Medical Association.

McCabe, S.J. (2002). 101 Questions and Answers About Carpal Tunnel Syndrome. New York, NY; Contemporary Books.

McKenzie, K., Lin, G., & Tamir, S. (2004). Thoracic outlet syndrome, part I: a clinical review. Journal of the American Chiropractic Association, 41(1), 17-24. Retrieved from EBSCOhost.

Murrell, K. H. (1958). The Term "Ergonomics". American Psychologist, 13(10), 602.

doi:10.1037/h0038393

Neck pain.. (cover story). (2009). Mayo Clinic Health Letter, 27(11), 1-3. Retrieved from

EBSCOhost.

Nunes, I. L. (2009). Ergonomic Risk Assessment Methodologies for Work-Related

Musculoskeletal Disorders: A Patent Overview. Recent Patents on Biomedical

Engineering, 2(2), 121-132. Retrieved from EBSCOhost.

Orr, S. (2007). Office Ergonomics Preventing Repetitive Motion Injuries & Carpal Tunnel

Syndrome. Lafayette, CA; Letsdoyoga.com.

Osborne, D. J. (1987). Ergonomics at Work. New York, NY: John Wiley & Sons.

Porter, Robert (2009). Carpal Tunnel Syndrome. In Merck Manual Home Health

Handbook (Vol. 3, pp. 601). Whitehouse Station, NJ: Merck Research

Laboratories.

36

Stanton, N., & Stammers, R. (2008). Bartlett and the future of ergonomics. Ergonomics,

51(1), 1-13. Retrieved from EBSCOhost.

Thoracic Outlet Syndrome. (2001). Retrieved August 15, 2011, from: URL

(www.documentingreality.com)

United States Bone and Joint Decade (2008). The Burden of Musculoskeletal Diseases

in the United States. Rosemont, IL; Boneandjointburden.org.

Werner, R. A. (2006). Evaluation of Work-Related Carpal Tunnel Syndrome. Journal of

Occupational Rehabilitation, 16(2), 207-22. Retrieved March 16, 2011, from

ABI/INFORM Global. (Document ID: 1213484761).

37

Appendix A: Survey Questionnaire

Chippewa Valley Technical College

Ergonomics Survey

1. My age is:

A. 18-29 B. 30-44 C. 45-59 D. 60+ E. Do not wish to answer

2. My gender is:

A. Female B. Male C. Other D. Do not wish to answer

3. I have been working in the cashiers office at CVTC for:

A. Less than 1 yr. B. 1 - 3 yrs C. 3-5 yrs. D. 5-10 yrs. E. 10+ yrs.

4. I have experienced neck pain or discomfort in the last 6 months T F

5. On a scale of 1-10(10 being highest), rank the intensity of pain _____

6. Explain where the pain of discomfort occurred(upper neck, lower neck, etc,)

________________________________________________________________________

7. In my estimation, this pain or discomfort was work-related T F

8. I have experienced back pain or discomfort in the last 6 months T F

9. On a scale of 1-10(10 being highest), rank the intensity of pain _____

10. Explain where the pain of discomfort occurred(upper back, middle back, lower back,

etc,) ___________________________________________________________________

11. In my estimation, this pain or discomfort was work-related T F

12. I have experienced shoulder pain or discomfort in the last 6 months T F

13. On a scale of 1-10(10 being highest), rank the intensity of pain _____

14. Explain where the pain of discomfort occurred(right side, left side, center, etc,)

_______________________________________________________________________

38

15. In my estimation, this pain or discomfort was work-related T F

16. I have experienced wrist pain or discomfort in the last 6 months T F

17. On a scale of 1-10(10 being highest), rank the intensity of pain _____

18. Explain where the pain of discomfort occurred(right side, left side, upper wrist, lower

wrist, etc,)

_______________________________________________________________________

19. In my estimation, this pain or discomfort was work-related T F

20. I have experienced pain or discomfort in the hands or fingers in the last 6 months

T F

21. On a scale of 1-10(10 being highest), rank the intensity of pain _____

22. Explain where the pain of discomfort occurred(fingers, hands, left or right side, etc,)

_______________________________________________________________________

23. For any of the pain or discomfort described above, the injury reported to a manager.

Y N

24. For any of the pain or discomfort described above, was any treatment conducted? If

so, please elaborate

_______________________________________________________________________

_______________________________________________________________________

39

Appendix B: Summary of Completed Surveys

Years Worked 1-3 10 +2 2

Yes No Did Not Answer Average Intensity Work-RelatedNeck Discomfort Upper Middle Lower Did Not Answer Yes No Unsure

3 1 4 1 0 1 0 1 1 1Back Discomfort Upper Middle Lower Yes No Unsure

4 0 5.75 1 1 2 0 1 1 2Shoulder Discomfort Left Side Center Right Side Yes No Unsure

3 1 5.33 1 1 1 1 2Wrist Discomfort Left Side Center Right Side Yes No Unsure

2 2 5.5 1 0 2 0 2 0 0Hand/Finger Discomfort Left Side Center Right Side Yes No Unsure

0 4 0 0 0 0 0 0 0 0Injury Reported Yes No

0 3 1Treatment Conducted

2 2 0

40

Appendix C

: Blank R

UL

ARULA Employee Assessment Worksheet

Complete tl1is worksheet fol lowing tl1e step-by-step procedure below. Keep [\ copy III tl1e employee's personnel folder for future reference.

A. Arm & Wrist Analysis

~P1 co": u"","ilk ."," . "~, .""". .,,..,%

Step 1:1: Adjust .. , r t,.~u d';' f !I ~;:I,,~d + 1

~ ~~ ~ ; ~r.~~p~~~~·C:t~~~l+:·r 1 iJn ·; .,

Step 2: Locate LowerArm Pos ition

fr 9("

< . vCfJ? "'JJ I-i?-.,f~. j'; ~~!) e·o5::

Step 2:1 : Adjust... t J~"" is \\'o~ ing Jcrou n'id ~e .:f t"t ~" d~ ; - ' f ,11 "~' CU', ~o!:e :Jfbc.:y + 1

:~IV" +

~,l1a' !. ,.,',fl 4'p' S";C:of

Step 3: Locate Wrist,~~sltion ,t _I ~_~ C.I'~\ -1 +1

~~~ ) c- r. f~" - , I 15· +

Step 3:1 : AdJust ,., I~ tlrJ.t 'So o.en: ' ren' t". "'10 ... t' F.""W:,,!:x,e=U

Step 4: Wrist Twist 1 'MI~ ( IS :1"i3Ied nl J nly I" mld-':1 I-C~ =1 ; f I'.vls: 3: (,e "eJr end 01 IWls: i ~O r Jnge = :2 '~ " IH T I, t~r :'t~r~ ::

1_ .. ~.~;~ i~:: ~~~::~~ :~o4s:;u;~t~;~~;rol~or~~le A D t,n,le- A F'O!t .. '£ :iX't .J ..

Step 6: Add Muscle Use Score + :: ~~:~;~';'~:;~(/i~~~Z:~'~:: "~;~'~ ~;~~::~:":} ,~~~;::-: ,0 ': .'Me', iJ~. ~:C· f· D

Step 7: Add Force!load Score f l o~: H\ ~ ... ~, .. ~ ~; : ,ott-fr" l:.n~ ' to f:k;~o ~Oki .. ~t""'l:l'''t: ... l (~k ·; ~O'O k; ~t'l::Jr 'tp.~:i: : :"': f "'::lIe t'".:\n 'O~; C~: :-t 'ipta:tO or sl")ck, 't~

Step 8: Find Row in Table C ""t :: .. ,: t-te : 'C:+ I ~ , ." .... :h. Anr ·."-;: In:: y'Sl! So • !eO: lC t." d ,,.-: ':I'~ on T.::be ':

+

SCORES Table A

VI V-

i

! I l l .

":

-Table C

Departme"'t:

B. Neck, Trunk & Leg Analysis

'~ . 75 ''D St.p ~r~;~'~:~ p"""

~~. ~~. ~~.' ~~.' Step 93: Adjust...

Table 6

'nf: -. sr.', ,:.d . 1 Inf'" S I O.·~.·ding - 1

, :0 x '· Step 10: Locate Trunk Position

~I>·'!J! ·'::YL!f2~ /-:;: II I,/" ./''' / I _,;;,'Y +4

' •• ,~ I t

Step 10a: Adjust... I :run .. t ~,I •• :.d + 1 t :run, s "ct·b.·e:ing - 1

Step 11: Legs , t;. & I .. t ,upp(nao and bal.n:.::-l l "'01 _~

-1".11"" Potur. Scere

Lt., I Ltg. I _.... I L.;'

, t • I • I & I • I • I • I •

e 1 1 1 . 1 ' 1 1 1 1 1, l t l , I , ' f I f

D Ste~ .~ ~,~ ~.~~~~~:~:~~:t~;'~;:P~~t~:~,I!.~n /I; PO:~ .• tf £ :; :'1~ r"b ~ 6 + Step 13: Add MU$cle U$e Score

D 1' ~O'l'J·. O'· "r Jla:ieor:

+ •• \lU!~:! LI!, ::'~'t I ~ Je':ion 4 1' rr 'rll~t.or "no<,. "!'.

Step 14: Add Forcelload Score , , ad I.ss :han ~ kg rttr,... r.tn:1 .~: I ~ .,g t:t ':1 .. g In:.nrl:1 .... t:: .. I , ~ ',g t:t 'J .. g ~It~~ e Gf ... Pt3~.d ~' -2 j" " ':rtl"'lH ': .. g l o.3:~"rtt.a:tdors!'ll)c,s.,.!

Step 15: Find Column in Table C " ~e- :C "l~ .e:I~: score fr..:n trt. NfcI.JTr ... rk.!. Le.;

tCh";GI'''f:~ r 'vn ... £ !..1 ;1 $:O(f In,~y''~ ~ .. H j :cr"' d ~,ecolurrnonC j"llr:C

Date: Scorer:

FINAL SCORE: 1 or 2 = Acceptable : 3 or 4 investigate further ; 5 or 6 investigate further and change soon; 7 investigate and change immediately SO I' I'Cl' .\1(JiGt)Ph"," , L ....\: C''''.h·'i. E.\" (} :J,'J3 ,1 R [ 'L~ r. 5:",' (,l 1",:,:.11~:1 t{H' rh t im !';;igarfoJJ (~('; " 01 ,i>"t"/rr!cd ~,'PPi" Ur"b d::ol'dl'15 .~PFlu'(j EI·r.o ~~o'nf(:, .l.J; _'I .tJ}·99.

l~ ~ P I '~(;'::(\I .1kl ll Hi'(/?l', .: O"Jt~'n t,'jl;'\'(f ':t':; ?t'/) . • 1~Oi

41

Appendix D

: Com

pleted RU

LA

(

RULA Employee Assessment Worksheet Complete this worksheet following t11e step-by-step procedure below, Keep tl copy 111 the employee's personnel folder for future reference,

A. Arm & Wrist Analysis

~p 1: Locate uppe~rArm PO@)Sition ""_J

-. ~ . .~ I J '. I 9,'

' . , •• 9Ct "1\, . .. +.:' t.P ) .:::-- .. :),:);,~ " ....

'.-si~p 1a: Adj~st." ,',u d" >"I .. d .;; , .' .f.i1

fu,p.';'" ~ :o~~"r:;.!:'; u n V f 3m' ! ! . ppe te. Arm Position ~: Loe3t~ Lower

•• ~ t< 1,'1 I-:-G·O

Step a: Adjust... f J'''' i. wor-ing .;c . o~, n'ld '.:f t·t :od) ; -' fJ-', ou: :os:~:.~ bc :'J t l

vw ~ :JlI'" +

C,ne ' !.,,,!' .4'1'~ $;c.'C'

~~~-I . 1

Step 3: Locate Wris\~~s lt i on ,"- 1) ~~ I

Step 3a: Adju st.., I'wr !ot .. c>&m/ICn" ''" 4 ""'ld " . t ' F,ot • • V:'~' :~,. ,,-1- 1...

Step 4: Wrist Twist f 'N r i ~t IS :Wi3t.:d n'Jlnly I" mld·ral~<;:~ =1 ; f tWIS: a: or ",",lr end of tWls:lrg r.1 l1ge = :? ,'''''J! i,',~t :.':,rf =

'_ "~JtJe~ ;~:: ~~~~. ~~ !1~~;u;,e'l~;:~~,~rt l ~or!~le A 13' t~~tIt A ~o=r ... lt :'C't't.-'. LL-J

Step 6: Add Muscle Use Score + :: ~~:~;~'~.~::;~:'..: :: "(~;;'~ ~;~~::~:~,I,~~;::~,< '; .. {u~~,~ L'~e ':, 'f' [l[]

Step 7: Add Force/load Score r IOJ~ u,: '.1" : \:- . , .. t!otl" l:tn: to f ~ k;:o '0 k; .. :t:"', :ttl'l:-I ( ~k·;~o "Ok; St21; or ' e-p"J~~:' : < ff'·ori t':. n ·O~~ ,~: :t~tP.J:toor sl')C~io "S

Step 8: Find Row in Table C "' ;- e- ::: .... u HH sC:IIe- t'~ I '" :he Am' .'~ ~ io: Jn ~ ~sj$ !. . 't~ It' I'd I"'~ .: t'. on Tl b f ~

+ ""';i,'_' ~:O" , I f;:' I -

SCORES Table A

VI V i

i i i

Table C

Departme'w

B. Neck, Trunk & Leg Analysis

~ ~ '%1 '''P n~;~~:'~ Pos""

\Jill) ~ h~" ~~ .' cF,oa' ,'.'t~ ', :Wf Step 93: Adjust...

' n<l::, ! h', s:td .1 fne:, S S:i!·ht:"I.oing ... 1

Table B

.. °O! ~ .• I~~· : ~()t~

:.>':0 ;c" Step 1 0: Lo~ate Trunk Position

~-~) ':IJI '~y~~ ~-:;~ ; I,/" ,.,-"

/ / 7'/" +4

Step 103: Adjust... • :run" ,:.', i :td , I hun" S l,ct·b.' clng · 1

•• ;s & t.!t supp:n~~~~~ b;~~'~~" 1_'1"': V

.,..·.' .. k FOi1./r, Sec,re

.f~O 1 L&£' I Logo I '.',' I Lt., , 1 : 11

~ I , I ,

, , t It I t I • I • I • I .

~ I t I ! I ! I t i S I , I • I I I •

Step 12: Look·up Posture Score In Table B • It \'3 -It!- ft:;Jf'\' \t."s. a 9 & ~o to: c:::t:t Post .. rt ~tOft In Tiob t 6

[iIJ',IIlI!:-ItLH. :: ~'o Step 13: Add Muscle Use Score

I' '!lstu p• ""3 fly iI.r,i¢ ~,:

1/1::~lon "',' f'I";tu~ .. .or .,,0.'.<:)

+ 1 Q. I. cCI;e ,'oa ~ :.'Off

. ~J~~:.~ :~_!:~~~drt~r~r;~~~~ Score • : -,0 I~ ':, 'Q • n:trrrl~t·I : . \ ':Y I ~ ',g to f: "0 t'l IJ: C ,;:" ".pt3~.d .2 1"";r.I"" ': '.g I0.3~c:"r4~t.l~tdorl"'OtI(S.?

Step 15: Find Column in Table C - " t :C 'l~ tie: SCOIe fr,:,t" Itt N""';r.rk & Lt ,;

I: C,,'jG~'Je:t-. l'Jun,.~Lft S:Otf 3 n~',., ! s.H :I :of"':j:·,ecolurr n on Chart:::

FINAL SCORE : 1 or 2 = Acceptable: 3 or 4. investigate fl![t~ 5 or 6 investigate further and change soon; 7 investigate and change immediately .sO "I '( t' .'t1(.:ialwlt".' I & :: 0 1 /f';, E.Y s} "."J3) in ·L~ a ;1.'1'\ i"l 1I .' t.\~:ICj /'0 1' r;it' Iii) ~';:ig(irjO.ll o.(~" 01 ,i>I't'hr:cd :.·PP ~' l Uillb d~:ol -d,',; . ~pp l"'Ni E pgO)iflW(C:, ).J(~ .' ,tJ} .0.').

Ig PI·(.:h:::O I .~la l l at.{i.y1f1t" . .: OI·,tt"]J' t·ji1 ... · I ~':i:: i'd,. _'CO.i