Chair Assessment Tool

Chair Assessment Tool

7 Steps to nominating the correct chair
Organisation*
Assessor Name*

First NameLast Name
Phone Number

Area CodePhone Number
Reference Number*
Client Name

First NameLast Name
Date

MonthDayYear
Date
Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Step 1 - Nature of Issue*

Significant & EnduringTemporary or CorrectiveHeavy Duty
Step 2 - Workplace*

8 Hour DayMulti-ShiftHeavy Duty
Step 3 - Usage*

Single UserHot Desk
Step 4 - Weight*

LightStandardHeavy
Step 5 - Height*

ShortAverageTall
Step 6 - Leg Length*

ShortAverageLongExtra LongOther
To calculate required seat depth, take a measurement from rear of seat to the back of the knee, and then deduct 50mm.

The green line represents a distance of 3 fingers or approximately 50mm ‘gap’ behind the knee.
Upload Image

Browse Files

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Step 7 - Mechanism*

StaticDynamic
CODE
STEP 1
CODE
STEP 2
CODE
STEP 3
CODE
STEP 3
CODE
STEP 4
CODE
STEP 5
CODE
STEP 6
CODE
STEP 7
Options

Seat SlideNeck / Head RestAdjustable ArmsCoccyx Seat
Fabric*

Standard Black PolyesterStandard Black 100% WoolOther
Quantity
If more than 1x
Trial Chair
Is a trial required before purchase
Location of Trial

On SitePosture Balance - Coburg NorthDistributor
Your Email*
example@example.com
Clients Email
example@example.com
Nominated Distributor*

No DealerDealerOther
Dealer Name*
Comments
Should be Empty: