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Seating Assessment Form - D3 Office Interiors

Hull Branch & Head Office: Stratsource House, Malmo Road, Sutton Fields Ind. Estate, Hull HU7 0YF
Telephone: 01482 878737 Fax: 01482 822424 Email sales@d3office.co.uk - Map and directions to Hull Branch

Leeds Branch: Unit 8 By-pass Park Estate, Sherburn-in-Elmet, North Yorkshire LS25 6EP
Telephone: 01977 681068 Fax: 01977 681619 Email sherburn@d3office.co.uk - Map and directions to Leeds Branch

Contact Name*

Contact Phone Number*

Contact Fax Number

Email Address*

Client Name

Address

Please provide a description of any musculoskeletal disorder and any previous injuries to your spine.
Also, please comment on any back pain experienced while seated and what makes that pain better or worse?

DIMENSIONS:

Weight (stones/kilos)

Height (feet and inches)

A. Height of lumbar above seat

B. Back of knee joint to floor

C. Back of buttock to back of knee

D. Seat surface to shoulder

E. Hip to hip

F. Shoulder width

G. Desk Height

Would you like arms on the chair? (Yes/No)

Desk Shape? (rectangle (R), corner (C) or wave (W)

Floor Type? (carpet, concrete etc.)