Back to Feature Article by Jeffrey Anshel, O.D.
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VDT Workplace Questionnaire
Work Practices:
2. How long have you worked at a VDT job? _________ 3. Type of work habits: (circle one) 4. How often do you clean your display screen? _________ Environment: Fluorescent overhead only
Window light: (please circle one) in front behind to the side 6. Walls: Color ________________ Shiny / Dull finish? 7. Desk surfaces: Color _________ Shiny / Dull finish? 8. How would you rate the brightness of the room? (please circle one) Display Screen:
10. What color is the background of your screen? __________________ 11. Viewing distance from your eye to VDT screen: _____________ inches. 12. Can the monitor be tilted? Y N
13. Can you adjust the monitor height? Y N 14. Do you notice the screen flicker? Y N 15. Does the screen have a glare filter? Y N 16. Top of VDT screen (above, equal to, below) eye level?
17. If above or below, by how many inches? ______________ Workstation: 19. Viewing distance from your eye to hard copy material:
____________ inches. 20. Reference material is (to the side, below) the screen? 21. If to the side, is it next to the screen or keyboard? Y N 22. Is this height adjustable? Y N
23. Is the monitor supported on a? (please circle one) stand desk CPU 24. Is this adjustable? Y N
25. Is all of your hard-copy material visible without significant movements? Y N Visual Symptoms: 27. Do you wear glasses while working at the VDT? Y N 28. If yes, what type? (please circle one) 29. Do you wear contact lenses while working at the VDT? Y N 30. If yes, what type? (please circle one)
1. Number of hours per workday of VDT viewing. _________
a) Intermittent—periods of less than 1 hour
b) Intermittent—periods of more than 1 hour
c) Constant—informal breaks, as required
d) Constant—regular breaks
e) Constant—no breaks, other than meals
5. Lighting in the work area: (circle all that apply)
Incandescent overhead only
Fluorescent and incandescent overhead
Fluorescent overhead and incandescent direct
Window light control (please circle one): curtains blinds (vertical/horizontal)
Desk Lamp/Task Light _________
Other (describe) __________________________________
very bright medium dim
9. What color are the letters on your screen? __________________
What type? glass mesh
18. Viewing distance from your eye to keyboard: ___________ inches.
26. Do you have any of these symptoms during or after VDT work: (circle all that apply)
Eyestrain Double Vision HeadachesBackache
Neck / Shoulder / Wrist ache Color Distortion Blurred Near Vision
Blurred Distant Vision Light Sensitivity Dry / Irritated Eyes
single vision bifocal progressive ("no-line bifocal")
soft gas permeable hard lenses