Tailored Ergonomic Seating Assessment

TESA has been designed in conjunction with a leading international Physiotherapist and Ergonomist to help you assess the ergonomic seating needs of your work colleagues or clients. This form can simply be used as a guide to help you select an appropriate chair or you can submit this form and we will assist by making some recommendations for you to consider.

Ergonomic Seating Assessment

Complete all sections for a comprehensive seating evaluation

👤Client Details

Full name *
Company
Email address *
Phone number
Address

State
Post code

📏Basic Measurements

Back of buttock to back of knee (cm)
Knee joint to floor, with shoes (cm)
Top of shoulders to seat cushion (cm)
Desk height, top of desk to floor (cm)
Approximate weight (kg)
Approximate height (cm)

Other relevant measurements

🧍Additional Body Measurements

Elbow height when seated (cm)
Eye level to monitor distance (cm)
Shoulder width (cm)
Hip width (cm)

📋Other Relevant Information

Medical conditions or injuries affecting seating

Rehab Provider / OH&S (Confidential)

Name
Company
Email
Phone

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Tailored Ergonomic Seating Assessment

Ergonomic Seating Assessment

👤Client Details

📏Basic Measurements

🧍Additional Body Measurements

💻Work Environment Assessment

🏥Health & Comfort Assessment

⏰Work Habits & Patterns

♿Accessibility Considerations

🪑Seating Preferences/Requirements

🏢Office/Workplace Specifications

📋Other Relevant Information

Rehab Provider / OH&S (Confidential)

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