Abstract
摘要勞工因為工作所引起的肌肉骨骼傷害（WMSD）相當普遍與嚴重，它不僅危害勞工的健康，降低公司生產力，同時也會增加社會成本。為了消除或降低肌肉骨骼傷害，各國的安全衛生組織極力推廣各種以人因工程觀點為改善基礎的防制流程，提供現場輔導的訪廠表單。各國所提供的訪廠表單大體上依循著「現場觀察」、「辨識危害」、「改善方案」、「績效評估」四大流程進行，就如同醫生看診的流程不外乎是「問診」、「診斷」、「治療」、「評估」一般。本研究透過比較美國、英國以及台灣共三個國家在訪廠表單的內容，依「現場觀察」、「辨識危害」、「改善方案」、「績效評估」等四個流程進行，列表比較各國的優缺點，從而提出建議使我國的訪廠表單臻於完善。現場觀察在於比較表單是否能完整且快速紀錄工作現場資訊、「辨識危害」在於比較表單是否能客觀指出危害等級與危害因子、「改善方案」在於比較表單是否能邏輯推導出具體的改善方案、「績效評估」在於比較表單是否能反應實質的改善績效。結果顯示，美國提出的動作分析可快速判定改善優先順序、英國提供的作業濾鏡可以有效率地對作業的危害因子(施力過大、不良姿勢、重複性過高)進行快篩；然而這兩個國家的缺點是在現場觀察中無法詳實不漏的紀錄作業描述、設施佈置、工作站配置圖、…等相關工作場所與作業數據；而且在改善方案方面，也無法以邏輯化的方式推導出各種可能的改善方案，須仰賴有深厚的人因工程與工程技術素養。相對的，我國的優點在於現場觀察除了可以充分的描述作業，並將這些資訊與數據結合成一個有關聯、有組織的作業描述，讓人明瞭這個作業的情形；在辨識危害中利用KIM檢核表與生物力學計算可以指出危害程度與危害因子；在改善方案的構想訂出一個邏輯化、循序漸進的改善方案發展的流程並搭配圖形化改善庫，使改善方案具體化；在「績效評估」可以具體的預估改善前後的生理壓力、與生產效率。整體而言，台灣的表單優於英美表單，比較不需要很深厚的人因工程與工程知識，使一般事業單位的工安衛人員容易上手；然而在辨識危害表單中必須讓KIM檢核表更加直覺化並且提供生物力學的分析軟體讓大部分使用者能輕鬆上手；改善方案的邏輯固然完善，但是對於現場人員而言，不夠直覺。建議未來可已將英國的作業濾鏡與勾選式表單加入我國的表單之中，使得這套表單更容易推行。關鍵字：肌肉骨骼傷害、累積性肌肉骨骼傷害、肌肉骨骼傷害危害因子、肌肉骨骼傷害防制表單、工作現場改善?AbstractWork-related musculoskeletal disorder (WMSD) is a common and serious occupational disease in industrialized countries, it affects the worker’s health, decreases productivity, and increases significant social cost. In order to prevent WMSDs, almost all countries have developed series of WMSD prevention worksheets. These worksheets are designed basically for ‘worksite observation’, ‘ risk factor identifying’, ‘ proposing improvement alternatives’, ‘ and evaluation of improvement’ procedures, similar to the standardized procedure in medicine practice: such as ‘symptom inquiry’, ‘diagnosis’, ‘treatment’, and ‘post-treatment evaluation’.This thesis compared the pros and cons of the worksheets of the US, UK, and Taiwan, and in a hope to come up with good recommendation for Taiwan. The items of comparison for worksite observation is the completeness and rapidity in recording worksite information, for risk factor identifying is to diagnose risk ratings and risk factors objectively, for proposing improvement alternatives is to derive consolidate design improvement ideas logically, and for improvement evaluation is to assess real cost effectiveness of the improvement effectively.The result shows that awareness checklist of the U.S. is able to prioritize the hazardous tasks for improvement quickly; the UK is good at its ‘work filter’ which can screen out unfavorable force, posture, and repetition for lifting operation intuitively and efficiently. Nevertheless the common drawbacks of these two countries are that the worksite observation does not guide the observers to record complete and sufficient information, such as facility layout, work pieces and tools, and the worker’s characteristics, operation and task description, and so forth; and for proposing improvement alternatives does not able to assist HSE in deriving consolidate design improvement ideas logically, they demand significant engineering knowledge, and therefore they are not suitable for field health and safety engineers (HSE).In contrast, the Taiwan worksheets are good at in recoding worksite information completely easily and to organize these information adhesively into a sound description of task performance, so that the worksite and operation information is fully understood by others; in risk factor identifying worksheet KIM checklist and biomechanical analysis are able to diagnosis risk rating and risk factors objectively; in proposing improvement alternatives worksheet, it is to derive visualized consolidate design improvement ideas can be visualized on the check-and-pick improvement flow chart and pictorial equipment library logically; and in improvement evaluation worksheet the effectiveness of both physiological stressors and productivity of pre- and post- improvement can be forecast. In all, the Taiwan worksheets are better than the U.S.’ or UK’s, because they demand less ergonomic and engineering expertise, and therefore the health and safety engineers (HSE) in the field can do it DIY with only a brief training. However, the Taiwan worksheets still need some improvements: the risk factor identifying worksheet should be able to make KIM checklist more intuitively and to provide biomechanical analysis software most accessible for general users; although the worksheet for proposing improvement alternatives is logic but it is still not intuitive enough for HSE engineers. It is recommended that the ‘work filter’ of the UK and checklists be blended into the Taiwan worksheets so that they can be made more intuitively for field workers and HSE engineers, so they can be diffused more easily and widely.Key words：WMSD, CTD, WMSD risk factor, WMSD worksheets, Workplace improvement