Display Screen Equipment (DSE) Assessment Form Template

• Name of DSE User

• Assessment conducted on

  Date

Risk Factors

Keyboards

• Is the keyboard separate from the screen?

  Yes

  No

  N/A

• Does the keyboard tilt?

  Yes

  No

  N/A

• Is it possible to find a comfortable keying position?

  Yes

  No

  N/A

• Are the characters clear and readable?

  Yes

  No

  N/A

Mouse, trackball etc

• Is the device suitable for the tasks it is used for?

  Yes

  No

  N/A

• Is the device positioned close to the user?

  Yes

  No

  N/A

• Is there support for the device user’s wrist and forearm?

  Yes

  No

  N/A

• Does the device work smoothly at a speed that suits the user?

  Yes

  No

  N/A

Display Screens

• Are the characters clear and readable?

  Yes

  No

  N/A

• Is the text size comfortable to read?

  Yes

  No

  N/A

• Is the image stable, ie free of flicker and jitter?

  Yes

  No

  N/A

• Is the screen’s specification suitable for its intended use?

  Yes

  No

  N/A

• Are the brightness and/or contrast adjustable?

  Yes

  No

  N/A

• Dose the screen swivel and tilt?

  Yes

  No

  N/A

• Is the screen free from glare and reflections?

  Yes

  No

  N/A

• Are adjustable window coverings provided and in adequate condition?

  Yes

  No

  N/A

Software

• Is the software suitable for the task?

  Yes

  No

  N/A

Furniture

• Is the chair adjusted correctly?

  Yes

  No

  N/A

• Is the small of the back supported by the chair’s backrest?

  Yes

  No

  N/A

• Are forearms horizontal and eyes at roughly the same height as the top of the DSE?

  Yes

  No

  N/A

• Are feet flat on the floor, without too much pressure from the seat on the backs of the legs?

  Yes

  No

  N/A

Environment

• Is there enough room to change position and vary movement?

  Yes

  No

  N/A

• Is the lighting suitable, e.g. not too bright or too dim to work comfortably?

  Yes

  No

  N/A

• Does the air feel comfortable?

  Yes

  No

  N/A

• Are levels of heat comfortable?

  Yes

  No

  N/A

• Are levels of noise comfortable?

  Yes

  No

  N/A

Final questions to users

• Has the checklist covered all the problems you may have working with DSE?

  Yes

  No

  N/A

• Have you experienced any discomfort or other symptoms which could attribute to working with DSE?

  Yes

  No

  N/A

• Does you take regular breaks working away from DSE?

  Yes

  No

  N/A

• Notes for questions above:

Declaration:

• DSE User's Signature

  Sign

• Date:

  Date