Name:____________________ | Ref. Dr:___________________ | Date: ________ |
Age: _______ | Gender: M / F | Dominance: R / L | Injured Hand: R / L |
N.I.O.S.H. 6 LIFT TASK: | Comments: |
Arm: _____ _____ _____ _____________________ Torso: _____ _____ _____ _____________________ Leg: _____ _____ _____ _____________________ High Far: _____ _____ _____ _____________________ Floor: _____ _____ _____ _____________________ High Near: _____ _____ _____ _____________________ |
PINCH & GRIP TEST: | Comments: |
GRIP TEST
Grip Right: _____ _____ _____ _____________________ Grip Left: _____ _____ _____ _____________________PINCH TEST Key Pinch Right: _____ _____ _____ _____________________ Key Pinch Left: _____ _____ _____ _____________________ Tip Pinch Right: _____ _____ _____ _____________________ Tip Pinch Left: _____ _____ _____ _____________________ Palmar Pinch Right: _____ _____ _____ _____________________ Palmer Pinch Left: _____ _____ _____ _____________________ |