Display Screen Equipment Assessment

• Assessment type

  DSE

• Name of Person being Assessed

• Company

  Select PT CSC Al-Met Roota Martract Other

  • PT
  • CSC
  • Al-Met
  • Roota
  • Martract
  • Other

• Conducted on

  Date
• Location
  Address

User Details

• Occupation

• Number of Hours of Use per Day

  Less than 1 hour

  1 to 3 hours

  4 to 6 hours

  Greater than 6 Hours

If you use Display Screen Equipment for less than 1 hour per day then complete section 8 only, otherwise complete sections 1 to 8 below.

Section 1 - Display Screens

• Are the characters clear and readable on the screen

  Yes

  No

• Is the text size comfortable to read

  Yes

  No

• Is the image stable - i.e free from flicker or jitter

  Yes

  No

• Are the screen graphics suitable for the intended use

  Yes

  No

• Is the brightness and contrast adjustable

  Yes

  No

• Is the screen at a comfortable viewing height - does the screen swivel & tilt

  Yes

  No

• Is the screen free from glare and reflections

  Yes

  No

• Are adjustable window coverings suitable for providing adequate shade

  Yes

  No

  N/A

Section 2 - Keyboard

• Is the keyboard separate from the monitor or screen.<br>(Select N/A if you use a laptop)

  Yes

  No

  N/A

• Can the keyboard be tilted<br>(Select N/A if using a laptop)

  Yes

  No

  N/A

• Is it possible to find a comfortable typing position

  Yes

  No

• Do you feel you need additional training on Keyboard Techniques

  No

  Yes

• Are the keyboard characters clear and readable

  Yes

  No

Section 3 - Mouse / Trackball

• Is the device suitable for its intended use

  Yes

  No

• Can the device be positioned close to you without stretching

  Yes

  No

• Do you require additional support for forearm or wrist during operation

  No

  Yes

• Does the device work smoothly and at a speed that suits you

  Yes

  No

• Do you require additional training to change mouse speed in the software settings

  No

  Yes

Section 4 - Software

• Is the software you use suitable for its intended use

  Yes

  No

• Do you require additional general training on the software you use.<br>(Do not include specialised software training if is not a mandatory part of your daily use)

  No

  Yes

Section 5 - Furniture

• Is your work station suitable to hold all necessary devices and papers etc.

  Yes

  No

• Can you comfortably reach all equipment and papers you need

  Yes

  No

• Do you require additional equipment such as a document holder

  No

  Yes

• Are all surfaces clear and free from glare or reflection

  Yes

  No

• Is your chair comfortable to use

  Yes

  No

• Is your seat height adjustable

  Yes

  No

• Does your seat have adjustable back height and is it tiltable

  Yes

  No

• Does your seat have working casters or glides

  Yes

  No

• Do you require additional back support

  No

  Yes

• Are your forearms horizontal and your eyes roughly the same height as the top of the screen

  Yes

  No

• Can you put your feet flat on the floor without too much pressure from the seat on your legs

  Yes

  No

Section 6 - Environment

• Do you have enough room to change position and vary movement

  Yes

  No

• Is the lighting at your workstation suitable

  Yes

  No

• Does the air feel comfortable ( i.e. not too dry)

  Yes

  No

• Can the temperature at the workstation be controlled to produce a comfortable environment

  Yes

  No

• Are the levels of noise in your area comfortable

  Yes

  No

• Are you able to take regular breaks from Display Screen work

  Yes

  No

Section 7 - Additional Information

• Do you have regular eyesight checks. (Minimum every 2 years)

  Yes

  No

• Do you require glasses specifically for Display Screen Work and no other reason. outside work

  No

  Yes

• If you are a disabled person, do you require any equipment or assistance

  No

  Yes

  N/A

• Do you have any health symptoms or discomfort that you contribute to working with your Display Screen Equipment (If YES please give details)

  No

  Yes

• Details of Health Symptoms

• Do you have any medical or other condition which may affect your working with Display Screen Equipment (If YES please give details)

  No

  Yes

• Details of Health Conditions

• Send to Department

  Send to H&S Department

Sign-Off

• Device Being Used

  Tablet

  PC / Desktop

• Employee Signature Ensure that all questions are answered if completing sections 1 to 7

  Sign

• Name