• Email
• Department
• Work Station Identification
• Date of Assessment

1. Employee

• Employee Name
• Is the workstation used habitually as a significant part of normal work?
• Yes   No
• If YES, what percentage of his/her working time is spent operating the DSE (if intermittent give estimated average)

2. Equipment

• Monitor

  Make and Model

  Swivel/tilt available?

  Yes     No

  Remarks

• Screen

  Stable Image?

  Yes     No

  Adjustable brightness?

  Yes     No

  Glare/reflection free?

  Yes     No

  Remarks

• Keyboard

  Make and Model

  Separate from monitor?

  Yes   No

  Tiltable?

  Yes   No

  Matt surface?

  Yes   No

  Legible keys?

  Yes   No

  Remarks

• Work Desk/Surface

  Adequate Strength/stability

  Yes     No

  Area adequate size?(inc. space for the processing of any involved paperwork)

  Yes     No

  Matt surface?

  Yes     No

  Adequate space for worker to gain a comfortable posture during any combined work/paperwork?

  Yes     No

  Surface non-reflective?

  Yes     No

  Remarks

• Work Chair

  Is chair adjustable?

  Yes     No

  Seat height adjustable?

  Yes     No

  Back height/tilt adjustable?

  Yes     No

  Remarks

• Ancillary Equipment (If required!)

  Document holder available?

  Yes     no

  Footrest available?

  Yes     No

  Suitable task light available?

  Yes     No

  Remarks

3. Environment

• Space Requirements

  Adequate for postural changes?

  Yes     No

  Remarks

• Lighting

  Adequate lighting levels?

  Yes     No

  Glare/reflections present?

  Yes     No

  Remarks

• Noise

  Causing distractions?

  Yes     No

  Disturbs speech?

  Yes     No

  Remarks

• Thermal Comfort

  Background temp' satisfactory?

  Yes     No

  Humidity adequate?

  Yes     No

  Ventilation adequate?

  Yes     No

  Remarks

4. User/Computer Interface

• Software

  Is software adequate for tasks?

  Yes     No

  Remarks

• General Safety

  Electrical hazards?

  Yes     No

  Trip hazards

  Yes     No

  Is equipment positioned safely?

  Yes     No

  Adequate space to allow easy Access/egress?

  Yes     No

  Remarks

5. REMEDIAL ACTION REQUIRED

6. WHAT IS THE MOST REASONABLY PRACTICAL SOLUTION?

7. CONFIRMATION

• Signature of Assessor

  Print Name Assessor
  Signature of Employee

  Print Name Employee

  Review Date (where applicable)

Guidance for DSE Workstation Assessment Checklist