GetSAFE 5.17.1 Working from Home Assessment

• 5.17.1 Working from Home Assessment and Agreement
  This assessment is to be completed by the employee and manager prior to approving a working from home request. Once completed, the Manager is to file with their HSE records.
  If an item or a condition presents a hazard that has the potential to cause an injury or illness, then it is to be assessed and risk ranked (very high, high, medium or low) by the manager and a corrective action to be recorded in PeopleSoft. For very high and high risk ranking items, working at home cannot proceed until a corrective action is implemented and reassessed. If an item is ‘Not Applicable’ then indicate NA against the item.
  

• Document No.

• Business Stream

  Select WIS Blackwoods Protector Alsafe Safety Source NZ Safety Australian Graphics Bakers Geminex Total Fasteners Bullivants Coregas

  • WIS
  • Blackwoods
  • Protector Alsafe
  • Safety Source
  • NZ Safety
  • Australian Graphics
  • Bakers
  • Geminex
  • Total Fasteners
  • Bullivants
  • Coregas
• Location
  Address

• Conducted on (Quarterly Frequency)

  Date

• Employee Name

• Managers Name

• Inspected By

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• Is there a separate office available to work in? If no then a suitable work area is required and must include a suitable desk and ergonomic chair.

  Yes

  No

  N/A

• Are there any sources of excessive or disruptive noise?

  Yes

  No

  N/A

• Does the layout of the workspace allow easy access to equipment?

  Yes

  No

  N/A

Supervision

• Has the employee received the necessary information and training to do the work safely (ergonomic and manual handling training).

  Yes

  No

  N/A

• Has there been an agreement made concerning work hours, work breaks etc. and communication arrangements?

  Yes

  No

  N/A

Ergonomics

• Has the GetSAFE ergonomic checklist been completed for the home work environment ( Refer to GetSAFE checklist 5.20.1)

  Yes

  No

  N/A

Electrical

• Are power points in good condition?

  Yes

  No

  N/A

• Have all work items such as laptops etc. had the electrical cords tested and tagged and in good condition?

  Yes

  No

  N/A

Emergency Control

• Inspection conducted by

  Sign