Ergonomic / DSE Assessment

• Document No.

• Employee Name

• Client

• Client Location

• Conducted on

  Date

• Prepared by

• Section

• Line Manager

• Workstation Location

• Hours of Work (% working time at employer office)

  0% - 29%

  30% - 49%

  50% - 74%

  75% - 100%

• Is there an assigned desk or hot desking policy

  Assigned Desk

  Hot Desk

• Does the employee work remotely

  Yes

  No

• Hand Dominance

  Left

  Right

• Existing MSD's

  Select RSI Back Wrist Neck Shoulder None

  • RSI
  • Back
  • Wrist
  • Neck
  • Shoulder
  • None

• Comment on Existing MSD's

• Eye Effects

  20/20 Vision

  Short-sighted wears Lens

  Short-sighted wears Glasses

  Long-sighted wears glasses

• Comments on Eye Effects

• How long since employees last eye test

• Is the employee taking micro breaks every 45 minutes

  Yes

  No

• Temperature

  Good

  Fair

  Poor

  N/A

• Noise

  Good

  Fair

  Poor

  N/A

• Lighting

  Good

  Fair

  Poor

  N/A

• Glare/Reflections

  Good

  Fair

  Poor

  N/A

• Humidity

  Good

  Fair

  Poor

  N/A

Equipment

• Chair

• Is the chair back rest tilt in a supported upright position?

  Yes

  No

• Is the chair back rest at correct height?

  Yes

  No

• Is the chair seat set at the correct height?

  Yes

  No

• Is the chair seat suitable for the employee (i.e. seat depth)?

  Yes

  No

• Are the arm rests adjustable?

  Yes

  No

• Feet are firmly supported on ground, no foot rest requirement?

  Yes

  No

• Desk

• Is the desk at a suitable height?

  Yes

  No

• Has the desk adequate leg clearance?

  Yes

  No

• Is the desk right-handed or left handed?

  Right

  Left

  N/A

• Is desk housekeeping of a good standard?

  Yes

  No

• Has the desk got storage units?

  Yes

  No

• Is the minimum area of 4.65sqm achieved?

  Yes

  No

• Monitors / Screens

• How many monitors does the employee use at the workstation?

  Select 1 2 3 4 5 6

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Are monitors / screens an adequate size?

  Yes

  No

• Are monitors / screens at a suitable height?

  Yes

  No

• Are monitors / screens at a suitable distance from the user?

  Yes

  No

• Can the monitors / screens tilt & swivel?

  Yes

  No

• Is the main monitor / screen centered?

  Yes

  No

• Accessories (Keyboard, Mouse etc.)

• In good working condition?

  Yes

  No

• Good Cable Management?

  Yes

  No

• Other Equipment

• Comments

Postures

• Are the arms, wrists and shoulders in good posture?

  Yes

  No

• Is the back in good posture?

  Yes

  No

• Enter photo of workstation set up following assessment

Alterations / Recommendations Actioned During Assessment

• 1. Lumbar support (Backrest height) was adjusted to more ergonomically correct position during the assessment.

• 2. Chair backrest adjusted to suit user (i.e. upright position).

• 3. Chair height adjusted to more ergonomically correct position during the assessment.

• 4. Screen position altered to approximately fingertip distance (30-60cm).

• 5. Screen height adjusted to more ergonomically correct position during the assessment.

• 6. Screen tilt adjusted to more ergonomically correct position during the assessment.

• 7. User centred to main screen during the assessment.

• 8. Pregnant User - Recommended that Operative liaises closely with Obstetrician/Medical Practitioner and HR with regard to continued suitability to work.

• 9. Recommended brief micro workstation break every 45 minutes.

• 10. User advised to maintain upright neutral posture whilst seated at the workstation.

• 11. Recommended that user liaises with HR as necessary with regard to provision of eye/eyesight testing.

Recommendations not actioned during the assessment

• 12. New wrist pad required for keyboard use.

• 13. New mouse pad required.

• 14. Desk height to be modified to 710-730.

• 15. New chair lumbar support required.

• 16. Chair requires servicing or replacing.

• 17. Footrest required.

• 18. Screen raisers required.

• 19. Laptop requires docking station and external accessories (i.e. keyboard and mouse).

• 20. Document holder required.

• 21. Housekeeping improvements required on workstation to ensure all frequently used items are in the central area and less used items moved to periphery of workstation.

• 22. Housekeeping under workstation to be addressed to ensure appropriate leg room.

• 23. Cable management to be improved under the desk.

• 24. Cable management to be improved on the desk.

• 25. Environmental issues (Heating, Humidity, Lighting etc.) - Maintenance to investigate.