First Name *

Surname *

Email *

What is your job? *

Which are of work are you in? (e.g. finance, sales, marketing...) *

What age range are you in? *

Are you generally in good health? *

How long have you been working from home? *

What sort of computer do you work with? (e.g. laptop, computer, tablet...) *

Do you work on your computer everyday and if so how many hours a day? *

Do you have breaks during the day other than lunch? *

Which room do you work in? *

Where do you have your work station? *

Who else is in the house when you work from home? *

If there are other people, are they a disruption?

Do you suffer from any pain or discomfort during or after working on your computer?

Is this condition something you had before you started working from home or something that’s developed since or got worse since?

Where do you feel pain? (e.g. back, shoulders, neck, arms, hands, fingers, legs...) *

Do you have headaches? *

Are you taking medication for these pains or any other unrelated conditions?

What kind of chair do you use? (e.g. office chair, dining room chair, sofa...) *

Do you use a foot rest or a wrist support? *