Title Page

  • Name

  • Conducted on

  • Home location you're working from

Overview (optional)

  • This section is optional and will be used for general information purposes

  • How comfortable is the 'working from home' setup?

  • How would you describe your home working environment?

  • During the work day, are you likely be distracted by others?

  • Take some photos of the area that you will be working from

  • Is there anything that your employer can do to improve your working from home setup?

Desk Area

  • Do you have a desk / table to work from?

  • Do you have adequate space to work comfortably?

  • Is there enough space underneath your desk to stretch your legs?

  • Are there trailing electrical cables around your working area that need to be tied up?

  • Is your working area warm, well-lit and well-ventilated?

  • Do you need a desk lamp to improve lighting?

  • Is your working area clutter free so that you can focus easily on the task?

  • OK, thanks for letting us know

Display Screens Set-Up

  • Is your chair set up correctly? Is your lower back supported and are your feet flat on the floor?

  • Do you have enough surface space on your desk to work comfortably?

  • Are your keyboard and mouse clean and within easy reach, without having to stretch?

  • Is your display screen clean and positioned so there is no glare from a window or light?

  • Is your display screen level with your eyes so it doesn’t cause discomfort to your neck or head?

  • Can you easily reach everything that you need without twisting and straining your upper body?

Fire & Electrical Safety

  • Are your smoke detectors working and checked regularly, e.g. every month?

  • Do you regularly dispose of waste, including papers, to prevent a build- up of fire ‘fuel’?

  • Does any electrical equipment spark or show signs of burns and so needs removing from use?

  • Do any wires look damaged or frayed and so need removing from use?

  • Do you regularly inspect your electrical equipment to check for signs of wear and tear?

  • Do you switch off equipment when not in use?

  • Do you have emergency arrangements in place in case of fire?

Stress and Welfare

  • Do you take regular breaks away from your workstation?

  • Do you carry out regularly stretches at your desk to avoid stiff or sore muscles?

  • Do you sit with a good posture or are you hunched over the desk?

  • Do you have easy access to first aid equipment if required?

  • If you regularly use a computer, do you have your eyes tested every year?

  • Can you easily reach everything that you need without twisting and straining your upper body?

Slips, Trips & Falls

  • Are floor coverings, such as carpets and rugs, secure?

  • Do you frequently carry hot drinks and food upstairs/downstairs and risk tripping?

  • Are stairways and corridors clear of trip hazards?

  • Is the floor area around your desk clear of boxes, papers and wires?

Lone Working

  • Do you know the name and number of a manager or supervisor who you can get in touch with easily?

  • Do you have a system for regularly ‘checking in’ with your employer if you are not visibly online each day?

  • Is your home kept secure whilst you’re working there?

  • Are important files and laptops kept locked away securely when not in use?

Manual Handling

  • Are all items that you need for work within easy reach?

  • Are heavy items stored on lower shelves to avoid the need for lowering them?

  • Do you know how to correctly pick up, carry and lower heavy items?

Sign off

  • Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.