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Medical History Checklist: Symptoms Survey for Work-Related Musculoskeletal Disorders (WMSDs) |
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What is a symptoms survey for work-related musculoskeletal disorders (WMSDs)?One element of an effective ergonomics program for the prevention of WMSDs is to ask workers questions about their health. A symptoms survey helps to find out when workers are experiencing any discomfort, pain or disability that may be related to workplace activities. Neck pain 10. | To what degree has your pain or discomfort interfered with your work, your life outside of work, and your sleep in the past year? |
Shoulder pain 15. | To what degree has your pain or discomfort interfered with your work, your life outside of work, and your sleep in the past year? |
Elbow pain 20. | To what degree has your pain or discomfort interfered with your work, your life outside of work, and your sleep in the past year? |
Wrist/forearm pain 25. | To what degree has your pain or discomfort interfered with your work, your life outside of work, and your sleep in the past year? |
Hand pain 30. | To what degree has your pain or discomfort interfered with your work, your life outside of work, and your sleep in the past year? |
Upper back pain 35. | To what degree has your pain or discomfort interfered with your work, your life outside of work, and your sleep in the past year? |
Lower back pain 40. | To what degree has your pain or discomfort interfered with your work, your life outside of work, and your sleep in the past year? |
Foot pain 45. | To what degree has your pain or discomfort interfered with your work, your life outside of work, and your sleep in the past year? |
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Document last updated on November 7, 2003
Copyright ©1997-2006 Canadian Centre for Occupational Health & Safety
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