Title Page
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Site conducted
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Conducted on
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Enter Name
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Location
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How many Hours Per day are you working on PC or Laptop?
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Do you use a Laptop or PC for Work ?
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Enter the Towers Serial & Model Number
Untitled Page
Section 1) Monitor
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Is the main monitor central to your desk and roughly an arms length away? (when sitting directly in front of the screen(s) in a neutral position)
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Is the monitor free from glare ?
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How many monitors do you use ?
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Does the monitor flicker ?
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Are your eyes level with the top of the screen? (keeping your head, neck & shoulders straight & relaxed)
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Can your monitor be tilted, raised or lowered?
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Does your monitor have brightness / contrast settings ?
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Is your text on your screen displayed in two or three times larger than the smallest text you can read?
Section 2) Chair
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Is your chair adjustable in height, padded, has free moving wheels and is stable?
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what is wrong with your chair ?
- height positioning doesn't work
- Not Padded Satisfactory
- Wheels don't work properly
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Does your chair have lumber support for your lower back?
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Do you Require a Lumber Support Pillow ?
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Do your feet reach firmly to the floor flat or reach a footrest when sitting in your chair ?
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Can you position your chair comfortably in front or under your desk ?
Section 3) Mouse
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Is your mouse a suitable shape and size and comfortable to use ?
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Please in short explain what is wrong with your mouse ?
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Does your wrist support your neutral position of your wrist ?
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would you benefit from a different kind of mouse ?
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which kind of mouse ?
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Are your mouse buttons stiff or overly sensitive ?
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Is your mouse kept clean and free from debris so it can move smoothly?
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Do you have to stretch to reach your mouse ? (advised position is to have your arm close to your side, with your elbow at a slightly open angle)
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Is your mouse wired or wireless?
Section 4) Keyboard
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Is your keyboard separate from the screen so it can suitably positioned?
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Is your keyboard directly in front of you, with the G, H and B keys in line with the centre of your body?
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Are the keys on your keyboard soft to touch and use? (not stiff)
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Are your elbows bent at around 90 degrees angle when typing? (your arms must be relaxed at the side of your body while typing)
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Are your wrists supported by either a desk or a wrist support when typing ?
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Do you need to stretch your wrists or forearms when typing ?
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Is your keyboard wired or wireless?
Section 5) Environment
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Your desk is made of material that does not cause glare?
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Your desk is at suitable height so that it has adequate space underneath?
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Your desk has enough room for all equipment you require ?
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All windows that could cause glare have blinds ?
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Your desk area have adequate lighting to prevent eye strain?
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Would you benefit from a desk lamp?
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The room is a suitable temperature? (Poor temperature can cause you to adapt a poor posture)
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Too hot or too cold ?
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Do you get Headaches or Migraines from using your computer ?
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Do you wear Glasses? (Either Prescription or Blue Light or Reading)
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Prescription, Reading or Blue light ?
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Did you know you can claim back the cost of your eye test?
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Please speak to Victoria for any information you require on this matter
Section 6) Laptops
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Do you have a stand or raised support for your laptop, so that you can adjust it to the appropriate height you need?
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Would you benefit from having a stand or support?
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Do you have a seperate Mouse and keyboard so you can adopt a proper posture ?
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How Many Hours are you working on a laptop per day ?
How you feel about work Station
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Do you feel that that your work station is satisfactory to work on?
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Please state what you do not feel is satisfactory?
Signature
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Please sign your signature
