Information

  • Magal_AWT_V.jpg
  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • DSE Assessment Record

  • Assessment
  • Select work department

  • Enter Employee Name

  • Enter Employee Pay Roll Number

Lighting

  • Is the lighting at your usual workstation adequate?

  • Are there distracting reflections on your screen?

  • Describe the issue.

  • Take a photo if possible to show the issue.

  • Do you have control over local lighting?

Temperature & Humidity

  • Are you usually comfortable at your workstation?

  • Is the air around your workstation:

  • Describe what the issue is that is making you uncomfortable.

Noise

  • Is the noise from other work equipment acceptable?

  • Describe the issues experienced.

  • Take photos of equipment generating the noise issue.

Space

  • Is there enough space around your workstation?

  • Describe the issue.

  • Take a picture of the desk area.

Chair

  • Is the seat height adjustable?

  • Is the angle and height of the backrest adjustable?

  • Is the chair stable?

  • Is the chair in a good state of repair?

  • Describe the what is wrong with the chair.

  • Take a photo of the chair.

  • Does the chair have arms?

  • Are the arms free from issues involving the workstation?

  • Describe the issues that the arm are causing.

  • Take a photo of the issue that the arms are causing.

  • Is the chair comfortable?

  • Describe the issues with the chair.

Desk

  • Is the desk surface large enough?

  • Take a picture of the working area.

  • Is the height of the desk suitable?

  • Describe the issues with the desk height i.e. Too high, Too low etc.

  • Take a picture.

  • Is the desk height suitable so that a foot rest is not required?

  • Has a foot rest been provided?

Document Holder

  • Do you require a document holder?

  • Has a document holder been provided?

  • Can you adjust your document holder to the right angle?

Display Screen and Keyboard

  • Is there a brightness control on your screen?

  • Is there sufficient difference between characters and background?

  • Is the screen image stable and free from flicker?

  • Is the computer a Desktop or Laptop?

  • Does your screen move freely?

  • Describe what is wrong with the item.

  • Take a picture of the issue.

  • Is the screen at a comfortable height for you?

  • Describe what is wrong with the item.

  • Take a picture of the issue.

  • Is the keyboard height adjustable?

  • Describe what is wrong with the item.

  • Take a picture of the issue.

  • Are the symbols on the keys easily visible?

  • Describe what is wrong with the item.

  • Take a picture of the issue.

  • Is there sufficient space in front of the keyboard to rest operators hands?

  • Are operators forearms parallel to the work surface?

  • Describe what is wrong with the item.

  • Take a picture of the issue.

  • Is the operators wrists comfortable?

  • Describe what is wrong with the item.

  • Take a picture of the issue.

  • Are the symbols on the keys easily visible?

  • Describe what is wrong with the item.

  • Take a picture of the issue.

  • Is there sufficient space in front of the keyboard to rest operators hands?

  • Are operators forearms parallel to the work surface?

  • Describe what is wrong with the item.

  • Take a picture of the issue.

  • Is the operators wrists comfortable?

  • Describe what is wrong with the item.

  • Take a picture of the issue.

Other Equipment

  • Is your phone located conveniently?

  • Describe the issues.

  • Take a picture.

  • Is there enough space to load paper into printers and copiers?

  • Describe the issues.

  • Take a picture.

  • Can you easily access shelf's above or below the workstation?

  • Describe the issues.

  • Take a picture.

  • Is all other equipment satisfactory?

  • Describe the issues.

  • Take a picture.

Training

  • Have you been trained in how to set up your workstation so it is comfortable?

  • Have you been trained in how to use your software?

  • Do you understand how to use your software?

  • Enter a date when training needs to be completed by.

  • Do you know who to contact if there is an issue with your workstation?

  • Do you know the company arrangements for eye tests?

  • Signature:

  • Insert date of assessment

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.