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元智大學-肌肉骨骼症狀問卷
一、因應職業安全衛生法第6條第2項預防重複性作業促發肌肉骨骼疾病，對本校所有教職員工實施自覺症狀調查「肌肉骨骼症狀調查表」(Nordic Musculoskeletal Questionnaire,NMQ)

二、本計畫之目的為預防工作者因長期暴露在設計不理想的工作環境、重複性作業、不良的作業姿勢或工作時間管理不當下，引起工作相關肌肉骨骼傷害、疾病之人因性危害的發生。

三、經本問卷評估如為輕微不適，請參閱計畫之改善方法進行改善或自行諮詢本校職醫；如為中等以上疼痛，將轉介職醫協助做進一步評估。  

These Measures are prepared in order to fulfill the requirements in Article 6 Paragraph 2 Occupational Safety and Health and to prevent work-related

University’s Directions for Managing Occupational Safety and Health and to prevent work-related musculoskeletal damage and ergonomic hazardous disorders for the University’s staff due to repeated operations and improper hardware design of the workplace, undesirable working postures, or extended working hours. If there are special requirements in other laws or other regulations or management procedures of the University, such requirements shall be followed.

 

Physicians and nurses providing health services in factories are responsible for helping with occupational health consultation

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基本資料 Basic Information

一、服務單位 Service Units
 *
二、工作內容  Job description *
三、職稱 Job title *
四、姓名 Name *
連絡電話 TEL *
連絡信箱 Mail *
五、性別 Gender *
六、年齡 Age
 *
七、年資 Senior
 *
八、身高 Height
*
九、體重 Weight
*
十、慣用手  Prefered using
 *
十一、您在過去的1年內，身體是否有長達2星期以上的疲勞、酸痛、發麻、刺痛等不舒服，或關節活動受到限制?  (若否，結束此調查表；若是，請繼續填寫下列表格。) In past 1 years,have you felt fatigue, soreness, numbness, tingling, etc. for more than 2 weeks, or restricted joint movement?
 *
十二、承上題，是否與工作環境或職業姿勢不良有關? Corresponding to the above，working environment and Poor posture related
Clear selection
十三、身體部位酸痛、不適或影響關節活動之情形持續多久時間?How long has the body part been sore, uncomfortable, or interfered with joint mobility?
Clear selection
B、症狀調查
任何部位請以酸痛不適與影響關節活動評斷，任選分數高者。
數字越大，代表疼痛程度越高，請參閱填表說明。
以肩關節為例：痠痛不適達2分、影響關節活動範圍達3分，故以3分計。
Choose the one with the highest score.
A score of 0 means no pain, and 10 means the worst pain you have ever felt.
For example shoulder joint 3 points、affects the range of motion of joints up to 3 points，so the score is three.
填表說明  
部位圖示
0(不痛no pain)
1(微痛mild)
2(中疼痛moderate)
3(非常痛severe)
4(劇烈痛very severe)
5(極度劇痛worst pain)
頸Neck
左肩Left shoulder
左手肘/左前臂 Left elbow/left forearm
左手/左手腕 Left hand/left wrist
左臀/左大腿Left hip/left thigh
左膝 Left knee
左腳踝/左腳 Left ankle/left foot
上背 Upper back
右肩 Right shoulder
右手肘/右前臂 Right elbow/right forearm
下背 Lower back
右手/右手腕right hand/right wrist
右臀/右大腿Right hip/right thigh
右膝right knee
右腳踝/右腳right ankle/right foot
Clear selection
Submit
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