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DEFINITIONS:

Workspace is defined as the area or part of a room where you usually work. It includes your furniture and the floor area around, but does not include any part of the room used by others or considered someone else’s workspace.

Workplace is defined as the entire work area of your department or agency.

Name

Job Title

E-mail Address

Department/Division/Program

How long have you worked for the company?

Phone Number/Extension

Date

What percentage of your files need to be at your finger tips?

Do the files need to be lockable?

Yes

No

Do the files fall under HIPPA guidelines?

Yes

No

What percentage of your files need to be a few steps from your workspace?

Do the files need to be lockable?

Yes

No

Do the files fall under HIPPA guidelines?

Yes

No

What percentage of your files need to be located on the same floor as your workspace?

Do the files need to be lockable?

Yes

No

Do the files fall under HIPPA guidelines?

Yes

No

Could the files be located in Shared High Density filling if possible?

Yes

No

What percentage of your files could be located in a central area within the building?

Do the files need to be lockable?

Yes

No

Do the files fall under HIPPA guidelines?

Yes

No

Could the files be located in Shared High Density filling if possible?

Yes

No

Do the files need to be Fire Proof?

Yes

No

Do the files need to be in a Climate Controlled room?

Yes

No

What percentage of your files could be located in a secure off-site facility?

Do the files fall under HIPPA guidelines?

Yes

No

Could the files be located in Shared High Density filling if possible?

Yes

No

Do the files need to be Fire Proof?

Yes

No

Do the files need to be in a Climate Controlled room?

Yes

No

WORK ACTIVITIES AND METHODS

In an average work week (40 hours), describe your typical work activities including the number of hours spent on each type of activity:

Concentrative work (using computer, reading, writing, etc.)

Collaborative work (team activities)

Using the telephone

Meetings

Out of office activities

Reviewing large documents

Training sessions

Other

Concentrative work (using computer, reading, writing, etc.)

Collaborative work (team activities)

Using the telephone

Meetings

Out of office activities

Reviewing large documents

Other

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