Welcome to the Remote Work Ergonomics Questionnaire.  As millions of professionals continue to work from home in 2026, musculoskeletal disorders have become a leading health concern. This sample template is designed to help individuals audit their home office setup or for HR teams to assess employee safety compliance. Use this questionnaire to identify risk factors for back pain, eye strain, and repetitive strain injuries.



Remote Work Ergonomics Questionnaire 

Section A: Workstation Setup

1. Is your monitor positioned at arm's length with the top of the screen at or slightly below eye level?

[ ] Yes
[ ] No

2. Do your elbows rest at a 90-degree angle with support while typing?

[ ] Yes
[ ] No

3. Are your feet flat on the floor or on a footrest while seated?
     [ ] Yes
     [ ] No

4. Does your chair provide adjustable lumbar (lower back) support that fits the curve of your spine?
     [ ] Yes
     [ ] No
5. Is your keyboard and mouse positioned close enough to avoid reaching forward?
     [ ] Yes
     [ ] No

  Section B: Lighting & Environment  


6. Is there any glare on your screen from windows or overhead lights?

     [ ] No (Good)
     [ ] Yes (Risk)

7. Is your room temperature maintained between 68–72°F (20–22°C) for optimal comfort?

     [ ] Yes
     [ ] No

8. Do you have access to natural light without it causing direct eye strain?
     [ ] Yes
     [ ] No

  Section C: Work Habits  


9. Do you follow the 20 20 20 rule (every 20 minutes, look 20 feet away for 20 seconds)?
     [ ] Yes
     [ ] No

10. Do you take a 5 minute movement break every hour?

      [ ] Yes
      [ ] No

11. Do you experience frequent headaches, neck pain, or dry eyes at the end of the workday?
      [ ] No
      [ ] Yes

  How to Use This Sample: 
 
  "This Remote Work Ergonomics Questionnaire can be adapted for:

  •  Personal Self Audit: Identify weak points in your home office setup.
  •  HR Compliance: Distribute to remote teams to ensure OSHA/Health & Safety compliance.
  •  Wellness Programs: Integrate into employee health challenges.
 
   Disclaimer: This sample is for informational purposes only and does not constitute medical advice.

Conclusion:  

Proper ergonomics is essential for long term health. Did you answer 'No' to more than 3 questions? You may be at risk for injury. Download this template   or copy the text above to start your safety audit today. Check out our other samples like the Computer Vision Syndrome Questionnaire for more health assessments.