Foreman Form

Postural Analyses of Coal Mining in Low Working Heights:

Effect of Working Height and Job Type

1. Subject Code ___________

2. Date ___________

3. Time ___________

4. Height (feet +inches) ___________ (meters) ______

5. Weight (lbs) ___________ (kilograms) ______

Body Mass Index (kg/m²) ______

6. Age (years) ___________

7. Time in job (years) ___________

8. Time in low height mines (years) ___________

9. Type of knee pad used ___________

10. Side SCSR is worn on ___________

11. Side cap lamp battery is worn on ___________

12. Weight of mining belt (lbs) ___________ (kilograms) ______

Items worn on mining belt: ­­­­­­­­­­­­­­­_________________________________________________

________________________________________________________________________

Least physically demanding task that you perform on a daily basis: _________________ ________________________________________________________________________

Most physically demanding task that you perform on a daily basis: __________________

________________________________________________________________________

Comments on knee pads used. _______________________________________________

________________________________________________________________________________________________________________________________________________

How often do you clean your knee pads? ______________________________________

How do you clean them? ___________________________________________________

Subjects will be asked the following questions by a NIOSH representative. This data will be used to determine whether or not an injury to the knee may have influenced the postures utilized by the subject.

Check all that apply:

____ Diagnosed knee injury:_________________________

____ Pain/Redness/Swelling in front of knee

____ Infection/ Hardening at the front of knee

____ Popping feeling in knee

____ Pain inside the knee

____ Catching/Locking of knee

____ Instability/Feeling like knee is going to give away

____ Knee stiffness after waking up

____ General knee weakness

Please check all tasks that you perform on a daily basis.

____ Moving about mine

____ Running continuous miner

____ Loading and unloading supplies

____ Rock dusting

____ Building stoppings

____ Advancing power load center

____ Hanging cable

____ Hanging curtain

____ Extending tubing

____ Other (please explain) _____________________________________

________________________________________________________

Task:_____________________________________________

How many hours do you spend performing this task on a daily basis? ____

Which two postures from the above chart (1-16) do you use most often?

1. _____ b)_____

What percentage of your time is spent in each posture (a, b)?

1. _____ % b) _____ %

Did the subject indicate that they used an obscure posture (posture not on list)?

If so, please describe.__________________________________________

____________________________________________________________

Task:_____________________________________________

How many hours do you spend performing this task on a daily basis? ____

Which two postures from the above chart (1-16) do you use most often?

1. _____ b)_____

What percentage of your time is spent in each posture (a, b)?

1. _____ % b) _____ %

Did the subject indicate that they used an obscure posture (posture not on list)?

If so, please describe.__________________________________________

____________________________________________________________

Task:_____________________________________________

How many hours do you spend performing this task on a daily basis? ____

Which two postures from the above chart (1-16) do you use most often?

1. _____ b)_____

What percentage of your time is spent in each posture (a, b)?

1. _____ % b) _____ %

Did the subject indicate that they used an obscure posture (posture not on list)?

If so, please describe.__________________________________________

____________________________________________________________

Task:_____________________________________________

How many hours do you spend performing this task on a daily basis? ____

Which two postures from the above chart (1-16) do you use most often?

1. _____ b)_____

What percentage of your time is spent in each posture (a, b)?

1. _____ % b) _____ %

Did the subject indicate that they used an obscure posture (posture not on list)?

If so, please describe.__________________________________________

____________________________________________________________

Task:_____________________________________________

How many hours do you spend performing this task on a daily basis? ____

Which two postures from the above chart (1-16) do you use most often?

1. _____ b)_____

What percentage of your time is spent in each posture (a, b)?

1. _____ % b) _____ %

Did the subject indicate that they used an obscure posture (posture not on list)?

If so, please describe.__________________________________________

____________________________________________________________

Task:_____________________________________________

How many hours do you spend performing this task on a daily basis? ____

Which two postures from the above chart (1-16) do you use most often?

1. _____ b)_____

What percentage of your time is spent in each posture (a, b)?

1. _____ % b) _____ %

Did the subject indicate that they used an obscure posture (posture not on list)?

If so, please describe.__________________________________________

____________________________________________________________

Task:_____________________________________________

How many hours do you spend performing this task on a daily basis? ____

Which two postures from the above chart (1-16) do you use most often?

1. _____ b)_____

What percentage of your time is spent in each posture (a, b)?

1. _____ % b) _____ %

Did the subject indicate that they used an obscure posture (posture not on list)?

If so, please describe.__________________________________________

____________________________________________________________

Task:_____________________________________________

How many hours do you spend performing this task on a daily basis? ____

Which two postures from the above chart (1-16) do you use most often?

1. _____ b)_____

What percentage of your time is spent in each posture (a, b)?

1. _____ % b) _____ %

Did the subject indicate that they used an obscure posture (posture not on list)?

If so, please describe.__________________________________________

____________________________________________________________

Task:_____________________________________________

How many hours do you spend performing this task on a daily basis? ____

Which two postures from the above chart (1-16) do you use most often?

1. _____ b)_____

What percentage of your time is spent in each posture (a, b)?

1. _____ % b) _____ %

Did the subject indicate that they used an obscure posture (posture not on list)?

If so, please describe.__________________________________________

____________________________________________________________

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