Information

  • ASSESSMENT TITLE

  • LOCATION WHERE ASSESSMENT IS CONDUCTED

  • ASSESSMENT CONDUCTED ON

  • ASSESSOR

Display Screen

  • Is the user an appropriate distance from the screen?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Is the screen adequate?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Are all the characters on the screen well defined and clearly formed of adequate size and spacing?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Are the images on the screen stable and free from flicker?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Can the screen brightness and contrast be adjusted for visual comfort?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Can the screen tilt and swivel?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Is the screen free from glare or reflections?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

SECTION SUMMARY

  • Remarks:

  • Add media

Keyboard

  • Is the keyboard tilt able and separate from the screen?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Does the keyboard have a non-reflective surface?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Are the characters clearly defined on the keyboard?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Are the positions of the keys on the keyboard comfortable to use?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

SECTION SUMMARY

  • Remarks:

  • Add media

The Desk

  • Is the work desk or surface large enough to accommodate all of the equipment?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Are the surfaces non-reflective?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Is there a document holder available?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

SECTION SUMMARY

  • Remarks

  • Add media

The Chair

  • Is the work chair stable?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Does the work chair allow freedom of movement?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Can the work chair be adjusted for height?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Can the work chair back rest be adjusted for height and tilt?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Can both feet be placed flat on the floor when seated at the workstation?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Is there a foot rest provided?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

SECTION SUMMARY

  • Remarks

  • Add media

Space Requirements

  • Is there sufficient space available to allow freedom of movement and change of position for the user?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Can documents and telephone equipment be handled in comfort and without excessive stretching?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

SECTION SUMMARY

  • Remarks:

  • Add media

Lighting

  • Is the lighting adequate at the screen and in the area of the workstation?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Does the screen attract reflections from artificial lights?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Does the screen attract reflections from windows or normal daylight?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Does the screen attract reflections from decor or other equipment?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Do windows have fitted adjustable coverings to control daylight?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Is the user in the correct position in relation to the window?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Is the user in the correct position in relation to the artificial lighting?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

SECTION SUMMARY

  • Remarks:

  • Add media

Software

  • Can the user control the pace of the software?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

SECTION SUMMARY

  • Remarks:

  • Add media

Noise

  • Do noise from adjacent work stations and or other equipment cause distraction?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

SECTION SUMMARY

  • Remarks:

  • Add media

Heat

  • Can heat from adjacent work stations and or other equipment be noticed?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

SECTION SUMMARY

  • Remarks:

  • Add media

Humidity

  • Is the temperature sufficiently adequate and comfortable?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Is the ventilation sufficiently adequate and comfortable?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

SECTION SUMMARY

  • Remarks:

  • Add media

General Safety

  • Are there electrical hazards, eg. worn or improperly connected cords?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Are there trip hazards, eg. trailing cables?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Is there clear and safe access/egress around the workstation?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Are working surfaces adequate in strength and stability?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Is the capacity for breaks or changes in work patterns permissible at this workstation?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Is the printer in a well ventilated position not close to any individual?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Is there a photocopier in the office?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Is there a water station available?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

SECTION SUMMARY

  • Remarks

  • Add media

Information

  • Has the worker been given all available information relating to the safe use of display screen equipment?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

SECTION SUMMARY

  • Remarks

  • Add media

Training

  • Has adequate training been given of the possible risks arising from the use of display screen equipment?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Has the operator been given adequate training in how to adjust the position of furniture and equipment at the workstation?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Is the operator encouraged to take regular breaks from on-screen activities?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Does the operator know how to use the brightness and contrast controls on his or her screen?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Has the operator been trained in the importance of adopting a comfortable posture at the workstation?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Is the operator trained in how to recognise visual or postural fatigue, and how to respond?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

SECTION SUMMARY

  • Remarks

  • Add media

User

  • Does the user wear glasses?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Does the user wear contact lenses?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Does the user adopt the correct posture sitting/standing?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Does the user adopt the correct positioning of the elbows when using the VDU?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Has the user any medical issues that need to be considered?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

SECTION SUMMARY

  • Remarks

  • Add media

Safety/Emergency Equipment

  • Is there a suitable first aid kit available?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Add media

  • Is there a suitable fire extinguisher available?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

  • Is there a fire alarm fitted or a smoke alarm fitted?

  • Action Required to correct issue:

  • Action by Whom:

  • Date for action to be completed by:

SECTION SUMMARY

  • Remarks

  • Add media

Sign Off

  • Remarks

  • Photograph of the work area

  • Person assessed, signature

  • Assessor Signature

  • Time/Date

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.