Title Page
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Name of Organisation for whom the assessee works.
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Location of premises where assessment relates
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Date of Assessment
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Assessment carried out by
1. Personal Details
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Please provide your personal details below
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1.1 Your Name
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1.2 What is your Role?
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1.3 Which Department do you work in?
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1.4 Who do you report to?
2. About the location of your Workstation
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You can support ANY or ALL of your answers by clicking
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Please take a Photograph to show what your Workstation looks like!
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2.1 Where is your Workstation located? E.G., Room X, or Office 1, or in the Packing Room etc. etc.
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2.2 Is the lighting in the workspace suitable and sufficient?
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2.3 Is there a functional blind to reduce/increase light from the window?
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2.4 Is the floor free from boxes, wiring and other obstacles which may cause someone to trip?
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2.5 Is the storage of paper and other stationery away from sources of fire?
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2.6 Are the wiring and electrical sockets in good working order?
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2.7 Is there enough room to change position and vary movement?
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2.8 Is the workplace free from distracting equipment noise?
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2.9 Is the temperature comfortable to work in throughout the seasons?
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2.10 Is the area free from draughts?
3. About the workstation
Workstation
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3.1 What type of workstation are you proposing to use? E.G., Office Desk and Chair with 5 Star Base or Rise and Fall Desk or Workbench and Stool etc. etc.
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3.2 Is the work surface large enough for all the necessary equipment and documents etc. etc?
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3.3 Are all surfaces free from sharp edges which could cause cuts?
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3.4 Is the work surface stable?
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3.5 Are work surfaces free from glare and reflection?
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3.6 Can you comfortably reach all the equipment and papers you need to use?
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3.7 Is there sufficient space for thighs and knees?
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3.8 Is there space to stretch your legs?
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3.9 Is there enough support for hands and wrists?
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3.10 What type of Computer are you using on the workstation?
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3.11 Is the software suitable for the task?
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3.12 Do you have sufficient training and knowledge in the use of the software?
Seating Arrangements
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3.13 What type of seating arrangement is in place?
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3.14 Is the chair/seat stable? I.E., comfortable, adjustable and on castors or slides?
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3.15 Does the chair/seat swivel to give access to other areas of the workstation?
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3.16 If the chair/seat is fitted with armrests, can it be manoeuvred close enough to the work surface?
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3.17 Are the mechanisms for adjustments easy to operate from a sitting position?
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3.18 Is the chair’s height adjustable?
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3.19 Does the seat pad provide adequate support for thighs and buttocks?
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3.20 Does the chair provide support for the lower back?
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3.21 Does the backrest adjust in height and tilt?
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3.22 Are forearms horizontal and your eyes just above the top of the screen?
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3.23 Are feet flat on the floor, without too much pressure from the seat on the backs of the legs?
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3.24 If feet do not touch the ground, do you have a footrest you can use?
- Yes
- No
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3.25 Have you adjusted your chair so as to be comfortable for the work you are doing?
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3.26 Do you have room to change your position and vary movement?
Display Screen(s)
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3.27 What is the Screen Configuration?
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Please describe "Other" Screen Type
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3.28 Is the screen free from glare and reflections from lights, windows or other images?
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3.29 Are you free from strong sources of light in your line of sight?
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3.30 Can the screen swivel?
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3.31 Can the screen tilt?
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3.32 Is the brightness adjustable?
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3.33 Is the contrast adjustable?
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3.34 Is the image stable, i.e. free of flicker and jitter?
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3.35 Are the characters clear and readable?
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3.36 Is the text size comfortable to read?
Keyboard and Mouse
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3.37 What type of Keyboard are you using on the workstation?
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Please describe other type of keyboard
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3.38 Is the keyboard in good working order?
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3.39 Does the keyboard tilt?
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3.40 Is the keyboard detachable/movable?
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3.41Are the characters on the keys easily readable?
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3.42 Does the keyboard have a numeric pad?
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3.43 Is it possible to find a comfortable keying position?
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3.44 Do you use good technique I.E., YOU DO NOT hit the keys too hard or flex your wrist?
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3.45 What type of Mouse/Pointer are you using on the workstation?
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Please describe other type of Mouse/Pointer
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3.46 Has a Mouse/Pointer pad been provided for use with the Mouse/Pointer?
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3.47 Is it suitable for the work you have to do?
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3.48 Is the Mouse/Pointer positioned close to the user?
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3.49 Is there support for the device user’s wrist and forearm?
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3.50 Does the device work smoothly at a speed that suits the user?
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3.51 Can you easily adjust software settings for speed and accuracy of Mouse/Pointer?
4. Other considerations
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4.1 Do you take regular breaks away from looking at a Display Screen?
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4.2 Do you suffer from aches or pains during normal work on any of the equipment?
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4.3 Do you suffer from eye strain?
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4.4 Have you had an eye and eye sight test within the last two years?
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4.5 Do you wear glasses as a result of an eye and eye sight test’s recommendations?
5. Declaration
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Please sign this declaration to say that to the best of your knowledge all the information you have provided is a true reflection of your Workstation arrangements and environment
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This is my signature
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If your device does not allow you to add your signature please sign another document, take a photograph of it and upload the photograph in the next question
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This is a Photograph of my signature