Boston Scientific Ergonomics Design Worksheet
Company:	Boston Scientific Corporation	Workstation/ Tool/ Equipment Name:	Click or tap here to enter text.	Links to Video/Photo: Click or tap here to enter text.
Prepared by:	Click or tap here to enter text.	Department:	Click or tap here to enter text.
Date:	Click or tap to enter a date.	Document Number:	Click or tap here to enter text.
The Ergonomics Design Worksheet provides a step-by-step approach to workstation, tool and equipment design. For each of the sections below indicate if the section content is applicable to the project. Links to potential recommended checklists and design specifications/guidelines are to the Engineering Ergonomics Reference Guide.
Workstation, Tool, Equipment – Identified/Defined
☐	NO	Has the workstation, tool or equipment of interest been identified/defined? (enter the item’s name and add any comments below)
☐	YES
☐	NA	Click or tap here to enter text.
Rapid Ergonomics Baseline Assessment of Risk (REBAR)
☐	NO	Has the REBAR been conducted for the project? (add any comments below) (insert the link to the REBAR form) Click or tap here to enter text.
☐	YES
☐	NA	Click or tap here to enter text.
Manufacturing Work Process
Potential Checklists/Specifications (links to checklists and specifications)
☐	NO	☐	YES	☐	NA	Work Process: Design Conventions and Human Behavior Checklist
Instructions
☐	NO	Have the workstation, tool or equipment manufacturing/work process instructions been reviewed and/or documented (if needed)? (add any comments below) (insert the link to the Instructions if available) Click or tap here to enter text.
☐	YES
☐	NA	Click or tap here to enter text.
Cycle Times, Takt Times and Line Balancing Guidelines
☐	NO	Have cycle times, takt times and line balancing been determined (if needed)? (add any comments needed below) (insert the link to the Guidelines if available) Click or tap here to enter text.
☐	YES
☐	NA	Click or tap here to enter text.
Job or Task Rotation Guidelines
☐	NO	Has job or task workforce rotation been factored in (if needed)? (add any comments below) (insert the link to the Guidelines if available) Click or tap here to enter text.
☐	YES
☐	NA	Click or tap here to enter text.

Workforce
☐	NO	Have the workforce demographics (age, gender, stature, morphology, hand dominance, etc.) been identified and incorporated into the design process (if needed)? (add any comments below) (insert the link to documents if available) Click or tap here to enter text.
☐	YES
☐	NA	Click or tap here to enter text.
Workbench/Chair
Potential Checklists/Specifications/Guidelines (links to checklists and specifications)
☐	NO	☐	YES	☐	NA	Workstation Checklist
☐	NO	☐	YES	☐	NA	Workbench Checklist
☐	NO	☐	YES	☐	NA	Workstation Selection Characteristics for Sitting and Standing Workbenches
☐	NO	☐	YES	☐	NA	Seated Workstation Guidelines
☐	NO	☐	YES	☐	NA	Seated Workstation Specifications
☐	NO	☐	YES	☐	NA	Standing Workstation Guidelines
☐	NO	☐	YES	☐	NA	Standing Workstation Specifications
☐	NO	☐	YES	☐	NA	Anti-Fatigue Mats/Insoles Checklist
☐	NO	☐	YES	☐	NA	Chair/Stool Checklist
Workbench Configuration
☐	NO	Has the configuration of the workbench been determined based on the work process and workforce demographics (if needed)? (add any comments below) (insert the link to documents if available) Click or tap here to enter text.
☐	YES
☐	NA	Click or tap here to enter text.
Chair Type and Adjustment
☐	NO	Has the chair type and adjustment features been determined (if needed)? (add any comments needed below) (insert the link to documents if available) Click or tap here to enter text.
☐	YES
☐	NA	Click or tap here to enter text.
Recommended Specifications for Workbench/Chair (complete as needed)
Seated or Standing (based on job task indicate if seated or standing work position is recommended)
☐	Seated	☐	Standing	☐	Sit/Stand
Workbench dimensions (insert recommended width and depth in inches and comments as needed)
Width	Comments	Click or tap here to enter text.
Depth
Workbench height adjustment (insert recommended fixed height or if adjustable lowest and highest height in inches, measured from top of worksurface and comments as needed)
Fixed	Comments	Click or tap here to enter text.
Lowest
Highest

Anti-fatigue mats (if used, indicate dimensions in inches and placement on the floor with comments as needed)
Width	Comments	Click or tap here to enter text.
Depth
Footrest (if used, indicate dimensions in inches and placement on the floor with comments as needed)
Height	Comments	Click or tap here to enter text.
Width
Depth
Chair type and adjustment features (if used, indicate recommended model and adjustment features with comments as needed)
Model	Click or tap here to enter text.	Comments
Seatpan	Height	☐	Tilt	☐	Click or tap here to enter text.
Depth	☐	Tension	☐
Back Support	Height	☐	Angle	☐
Arms	Height	☐	Side-to-side	☐
Rotate	☐
Parts/Materials/Trash
Parts/Materials
☐	NO	Has a list of all of the parts/materials required for the workstation being delineated (if needed)? (add any comments below) (insert the link to documents if available) Click or tap here to enter text.
☐	YES
☐	NA	Click or tap here to enter text.
Storage/staging Locations
☐	NO	Have storage/staging locations of parts/materials been determined (if needed)? (add any comments below) (insert the link to documents if available) Click or tap here to enter text.
☐	YES
☐	NA	Click or tap here to enter text.
Trash Receptacles
☐	NO	Has a location and handling of trash receptacles been determined? (if needed)? (add any comments below) (insert the link to documents if available) Click or tap here to enter text.
☐	YES
☐	NA	Click or tap here to enter text.
Tools
Potential Checklists/Specifications (links to checklists and specifications)
☐	NO	☐	YES	☐	NA	Hand Tool Design and Selection Checklist
☐	NO	☐	YES	☐	NA	NIOSH Guide to Selecting Non-Powered Hand Tools
Tools and Instructions
☐	NO	Have the tools and instructions in their use for the workstation been delineated (if needed)? (add any comments below) (insert the link to the tools and instructions if available) Click or tap here to enter text.
☐	YES
☐	NA	Click or tap here to enter text.
Equipment
Potential Checklists/Specifications (links to checklists and specifications)
☐	NO	☐	YES	☐	NA	Fixture Checklist
☐	NO	☐	YES	☐	NA	Hand and Foot Control Checklist
☐	NO	☐	YES	☐	NA	Recommended Specification for Hand Control Location
☐	NO	☐	YES	☐	NA	Contact Stress Checklist
☐	NO	☐	YES	☐	NA	Microscopes/Magnifiers Checklist
☐	NO	☐	YES	☐	NA	Computer Equipment Checklist
☐	NO	☐	YES	☐	NA	Machine Clearance and Maintenance Accessibility Checklist
Equipment and Instructions
☐	NO	Have the all the equipment and instruction in their use for the workstation been delineated (if needed)? (add any comments below) (insert the link to the equipment and instructions if available) Click or tap here to enter text.
☐	YES
☐	NA	Click or tap here to enter text.
Material Handling
Potential Checklists/Specifications (links to checklists and specifications)
☐	NO	☐	YES	☐	NA	Manual Material Handling Checklist
☐	NO	☐	YES	☐	NA	Recommended Specifications for Manual Material Handling Zones
Material Handling and Instructions
☐	NO	Have the Manual Material Handling requirements been determined (if needed)? (add any comments below) (insert the link to manual material handling instructions if available) Click or tap here to enter text.
☐	YES
☐	NA	Click or tap here to enter text.
Carts
Potential Checklists/Specifications (links to checklists and specifications)
☐	NO	☐	YES	☐	NA	Carts Checklist
Carts and Instructions
☐	NO	Have the Cart requirements been determined (if needed)? (add any comments below) (insert the link to carts and instructions if available) Click or tap here to enter text.
☐	YES
☐	NA	Click or tap here to enter text.
Conveyors
Potential Checklists/Specifications (links to checklists and specifications)
☐	NO	☐	YES	☐	NA	Conveyors Checklist
Conveyors and Instructions
☐	NO	Have the Conveyor requirements been determined (if needed)? (add any comments below) (insert the link to conveyors and instructions if available) Click or tap here to enter text.
☐	YES
☐	NA	Click or tap here to enter text.
Storage (Shelves/Racks)
Potential Checklists/Specifications (links to checklists and specifications)
☐	NO	☐	YES	☐	NA	Shelves/Racks Checklist
Storage and Instructions
☐	NO	Have the Storage requirements been determined (if needed)? (add any comments below) (insert the link to storage and instructions if available) Click or tap here to enter text.
☐	YES
☐	NA	Click or tap here to enter text.
Environment
Potential Checklists/Specifications (links to checklists and specifications)
☐	NO	☐	YES	☐	NA	Work Environment Checklist
Environment and Instructions
☐	NO	Have the Work Environment requirements been determined (if needed)? (add any comments below) (insert the link to environment and instructions if available) Click or tap here to enter text.
☐	YES
☐	NA	Click or tap here to enter text.
Comments
Click or tap here to enter text.