GIG Display Screen Assessment

• Site

• Conducted on

  Date

• Prepared by

• Location
  Address

DETAILS OF OPERATIVE

• Name

• Job title

• Date of Assessment

  Date

PART 1 - USER ASSESSMENT

• Do you currently need glasses for using a computer

  Yes

  No

  N/A

• Do you work work from home using a PC

  Yes

  No

  N/A

• Do you use a laptop for work

  Yes

  No

  N/A

• How many hours a day do you spend on average using a PC

• If you have breaks in your day, how many do you have

• How long are your breaks (Minutes)

• Do you experience discomfort in any of the following areas

• Eyes

  None / Rarely

  Aches

  Pain

  Tingling / Numbness

  Restricted movement

• Seek medical help

• Head

  None / Rarely

  Aches

  Pain

  Tingling / Numbness

  Restricted movement

• Seek medical help

• Neck

  None / Rarely

  Aches

  Pain

  Tingling / Numbness

  Restricted movement

• Seek medical help

• Shoulders

  None / Rarely

  Aches

  Pain

  Tingling / Numbness

  Restricted movement

• Seek medical help

• Upper Back

  None / Rarely

  Aches

  Pain

  Tingling / Numbness

  Restricted movement

• Seek medical help

• Arms

  None / Rarely

  Aches

  Pain

  Tingling / Numbness

  Restricted movement

• Seek medical help

• Wrist or Fingers

  None / Rarely

  Aches

  Pain

  Tingling / Numbness

  Restricted movement

• Seek medical help

• Side or Lower Back

  None / Rarely

  Aches

  Pain

  Tingling / Numbness

  Restricted movement

• Seek medical help

• Buttocks

  None / Rarely

  Aches

  Pain

  Tingling / Numbness

  Restricted movement

• Seek medical help

• Legs

  None / Rarely

  Aches

  Pain

  Tingling / Numbness

  Restricted movement

• Seek medical help

• Ankles

  None / Rarely

  Aches

  Pain

  Tingling / Numbness

  Restricted movement

• Seek medical help

• Are you affected by the following symptons

• Fatigue

  Never

  Rarely

  Sometime

  Often

• Pressure

  Never

  Rarely

  Sometime

  Often

• Stress

  Never

  Rarely

  Sometime

  Often

• Anxiety

  Never

  Rarely

  Sometime

  Often

• Software

• Is the software easy to use

  Yes

  No

  N/A

• Have you received training in the use of software

  Yes

  No

  N/A

• Do you feel that you may require further training

  Yes

  No

  N/A

PART 2 - WORKSTATION ASSESSMENT

• Does the Computer comply with the following

• The Keyboard is separate and tiltable

  Yes

  No

  N/A

• The keyboard has a Matt surface and the symbols are legible

  Yes

  No

  N/A

• The screen will tilt and swivel

  Yes

  No

  N/A

• The mouse can be used close to the body

  Yes

  No

  N/A

• Does the mouse operate efficiently

  Yes

  No

  N/A

• The screen is kept clean

  Yes

  No

  N/A

• Controllable screen brightness and contrast

  Yes

  No

  N/A

• Are the screen characters in focus and image not flickering

  Yes

  No

  N/A

• Is the screen free from reflection and glare

  Yes

  No

  N/A

• Does the seating comply with the following:

• Are the electrical cables in good order and condition

  Yes

  No

  N/A

• Is the Noise at a level suitable conversation

  Yes

  No

  N/A

• Is the Temperature at a comfortable level

  Yes

  No

  N/A

• Is there Adequate ventilation with no draughts

  Yes

  No

  N/A

• Is the Lighting indirect

  Yes

  No

  N/A

• Work area is not overcrowded

  Yes

  No

  N/A