DSE Workstation Assessment Form

• Audit conducted by

• Document No.

• Conducted on

  Date
• Location
  Address

Employee Details:

• Name:

• Contact information including telephone and email address:

• Working status? I.e Full Time? Part Time? Contractor?

• Employed? Self employed?

For Assessor/Line Manager to complete:

• Workstation location and number (if applicable)?

• Assessor name?

• Checklist completed by?

• Date of assessment?

Line manager name and contact details?

• Assessment checked by?

• Any further action needed?

• Follow up action completed on?

MAIN ASSESSMENT QUESTIONS

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? I.e is free of flicker?

  Yes

  No

  N/A

• Is the screens specification suitable for its intended use?

  Yes

  No

  N/A

• Are the brightness and/or contrast adjustable?

  Yes

  No

  N/A

• Does 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

• Are adjustable window coverings provided and in adequate condition ?

  Yes

  No

  N/A

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

• Do you have good keyboard technique?

  Yes

  No

  N/A

• Are the characters on the keys easily readible?

  Yes

  No

  N/A

Mouse, pointing device

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

  Yes

  No

  N/A

• Is the device positioned close to you?

  Yes

  No

  N/A

• Is there support for your wrist and forearm?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Can you easily adjust software settings and accuracy of the pointer?

  Yes

  No

  N/A

Software

• Is the software suitable for the task?

  Yes

  No

  N/A

Furniture

• Is the work surface large enough for all the necessary equipment and papers etc?

  Yes

  No

  N/A

• Can you comfortably reach all of the equipment and papers you need to use?

  Yes

  No

  N/A

• Are surfaces free from glare and reflection?

  Yes

  No

  N/A

• Is the chair suitable and stable? Does the chair have a working:

  Yes

  No

  N/A

• Seat back height and tilt adjustment?

  Yes

  No

  N/A

• Seat height adjustment?

  Yes

  No

  N/A

• Swivel mechanism?

  Yes

  No

  N/A

• Castors?

  Yes

  No

  N/A

• Glides?

  Yes

  No

  N/A

• Is the chair adjusted correctly?

  Yes

  No

  N/A

• Is the small of the back supported by the chairs backrest?

  Yes

  No

  N/A

• Are forearms horizontal and eyes roughly the same height as the VDU?

  Yes

  No

  N/A

• Is the seat depth adjustable to allow a gap of approx. 2 fingers between the back of the knees and front of the seat?

  Yes

  No

  N/A

• Are feet flat on the floor or foot rest, 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 the levels of noise comfortable?

  Yes

  No

  N/A

Final questions

• If you have other problems with your VDU workstation that are not addresses above then please mention them here.

• Have you experienced any discomfort or other symptoms which you attribute to working with the VDU? Please list details here:

• A you aware of your entitlement to eye and eyesight testing?

  Yes

  No

  N/A

• Do you ensure that you take regular breaks away from DSE's?

  Yes

  No

  N/A

• Do you experience any ill health, that you feel is attributed to the use of the DSE? If so it may indicate that reassessment is required. Highlight this to your Health and Safety Coordinator who will arrange for a reassessment to be undertaken.

Assessor findings and recommendations: