Donworth Office Interiors Questionnaire (www.donworth.ie)

Chair User Trial Questionnaire
Please print this form out and follow the instructions trying to answer all the questions. Responses will be kept confidential.

Section A (User)

Age:_____ Height:_________ Sex:________________ Chair Type:___________________

Are you a back sufferer?_____________________

If so what is the nature of the pain and are you seeking treatment? _________________________________________________________

Section B (Adjustment and general comfort)

Use the following scale (by circling the number which best describes your response) to answer the questions below:

1 = very difficult 2 = quite difficult 3 = moderately easy 4 = very easy 5 = extremely easy

1. While you are sat at the chair how easy do you find operating the following adjustment levers? (Answer where applicable)

Seat height: 1 2 3 4 5

Back height: 1 2 3 4 5

Seat/back recline: 1 2 3 4 5

Tension: 1 2 3 4 5

Seat depth: 1 2 3 4 5

Arm height: 1 2 3 4 5

Freefloat*: 1 2 3 4 5

*Facility allowing the chair to move while you recline backwards and come forward

2. Having adjusted your chair into an upright position how do you find sitting while writing/using the computer

VERY GOOD

QUITE GOOD

MEDIUM

QUITE BAD

VERY BAD

3. Having adjusted your chair into a reclined position how do you find sitting while reading?

VERY GOOD

QUITE GOOD

MEDIUM

QUITE BAD

VERY BAD

4. Adjust the seat/back angle into the most comfortable position for working at the desk
(writing or using the computer). Please indicate which angle best reflects the seat/back position
you have chosen:

UPRIGHT

SLIGHTLY RECLINED

COMPLETELY RECLINED

5. While staying in this working position please answer the following:

A: General comfort rating. Please rate the chair you are using now with a cross on the line next to the
phrase that best describes how you are feeling generally.

_____ I feel completely relaxed	_____ I feel perfectly comfortable
_____ I feel quite comfortable	_____ I feel barely comfortable
_____ I feel uncomfortable	_____ I feel restless and fidgety
_____ I feel cramped	_____ I feel stiff
_____ I feel numb (or pins and needles)	_____ I feel sore and tender

B: PBD scale Please rate the various parts of your body, circling the number above the phrase which
best describes the level of comfort you are feeling.

1. Neck	1	2	3	4	5
	No pain / discomfort		Moderate pain / discomfort		Extreme pain / discomfort
2. Shoulders	1	2	3	4	5
	No pain / discomfort		Moderate pain / discomfort		Extreme pain / discomfort
3. Upper back	1	2	3	4	5
	No pain / discomfort		Moderate pain / discomfort		Extreme pain / discomfort
4. Upper arms	1	2	3	4	5
	No pain / discomfort		Moderate pain / discomfort		Extreme pain / discomfort
5. Mid back	1	2	3	4	5
	No pain / discomfort		Moderate pain / discomfort		Extreme pain / discomfort
6. Forearms	1	2	3	4	5
	No pain / discomfort		Moderate pain / discomfort		Extreme pain / discomfort
7. Lower back	1	2	3	4	5
	No pain / discomfort		Moderate pain / discomfort		Extreme pain / discomfort
8. Buttocks	1	2	3	4	5
	No pain / discomfort		Moderate pain / discomfort		Extreme pain / discomfort
9. Hands	1	2	3	4	5
	No pain / discomfort		Moderate pain / discomfort		Extreme pain / discomfort
10. Thighs	1	2	3	4	5
	No pain / discomfort		Moderate pain / discomfort		Extreme pain / discomfort
11. Legs	1	2	3	4	5
	No pain / discomfort		Moderate pain / discomfort		Extreme pain / discomfort
12. Feet	1	2	3	4	5
	No pain / discomfort		Moderate pain / discomfort		Extreme pain / discomfort

6. Do you have any other comments, good or bad, to make about the comfort and how easy the furniture was to use?

Donworth & Co Ltd,
Celia House, Forge Hill, Cork.
Tel. 0035 321 431 8890 Fax 0035 321 431 8886