DSE and Workstation Assessment

• Conducted on

  Date

• Name

• Prepared by

• Location

  Select

• Department

• Job role

• Manager

• Date of Birth

Office Description

• Layout and position

• Lighting and glare

• Floor

• Noise

• Any other comments

Workstation description

• Chair

• Desk

• DSE

• Keyboard

• Mouse

• Other accessories

• Do you work from home?

  Yes

  No

• What is your workstation setup at work like? Is it set up as per your training?

• Any other comments

Issues

• Do you suffer from headaches?

  Yes

  No

  Sometimes

• Do you get backache?

  Yes

  No

  Sometimes

• Do you suffer from neck or shoulder pain?

  Yes

  No

  Sometimes

• Do you get any aches or pains in your arms when you work with computers?

  Yes

  No

  Sometimes

• Do you get aches or pains in your hands or fingers when working with computers?

  Yes

  No

  Sometimes

• Is more than 50% of your time at work spent at a computer?

  Yes

  No

  Sometimes

• Do you feel the need to squint or experience discomfort when your eyes focus on the screen?

  Yes

  No

  Sometimes

• Do you wear glasses or contact lenses when working?

  Yes

  No

  Sometimes

• Please provide details

• Do you use a laptop away from your desk for more than 30% of the time?

  Yes

  No

• What is your height?

Pre-existing conditions

• Are you pregnant?

  Yes

  No

• If so, when is your due date?

  Date

• Do you have a condition that requires an adjustment to your workstation or area?

  Yes

  No

• Please provide details

• Any further comments

Workstation Setup

• Sit in your normal position and stretch your arms in front of you. Do your fingertips touch the screen?

  Yes

  No

• Can you move your screen so that it is within your reach when your arms are stretched out in front of you?

  Yes

  No

• Is the screen directly in front of you?

  Yes

  No

• If not, can you move it so that you sit directly facing the screen?

  Yes

  No

• Imagine a horizontal line from your eyes to the screen. Does that line fall somewhere in the top third of the screen?

  Yes

  No

• Are you able to adjust the height of the screen?

  Yes

  No

• While using your keyboard, are your forearms supported by either the desk or the arms of your chair?

  Yes

  No

• If not, are you able to adjust the arms of your chair or the position of the keyboard so that your forearms are supported?

  Yes

  No

• Is it possible for you to position the keyboard so there are no stretched or trailing cables across your desk?

  Yes

  No

• If not, can you prevent it by plugging the cable into the USB port on the side of the screen (if there is one?)

  Yes

  No

• Is the keyboard directly in front of you?

  Yes

  No

• If not, can you place it in front of you?

  Yes

  No

• Is there enough space to rest your hands in front of the keyboard?

  Yes

  No

• If not, can you move the keyboard back?

  Yes

  No

• Is the mouse easy to reach and use?

  Yes

  No

• If not, can you rearrange your desk so that the mouse is easy to manoeuvre?

  Yes

  No

• Does your job require you to use the telephone while typing?

  Yes

  No

• Are you required to type while using the telephone for more than 50% of the time?

  Yes

  No

• Do you find yourself tucking the handset under your chin?

  Yes

  No

  Sometimes

• As you sit at your desk, are your feet flat on the floor with thighs parallel to the ground?

  Yes

  No

• Can you adjust your chair to achieve this position?

  Yes

  No

• Is your chair comfortable and stable?

  Yes

  No

• Does your chair support your lower back?

  Yes

  No

• Further comments

Sign-off

• I have confirmed that the information on this assessment is correct and am happy for this information to be shared with my manager, HR and Occupational Health as needed.

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