• Recovre Home Based WHS & Ergonomic Self Assessment

  • Document Number

  • Employee Name:

  • Location
  • Conducted on

  • Manager for Office Location:



  • Lumbar support is adequate and positioned in lower back curve?

  • Chair adjusted to optimise posture. Shoulders are positioned slightly behind hips and knees level with hips?

  • Armrests not stopping chair from accessing desk?

  • Desk height adjusted to ensure shoulders are relaxed, elbows bent and forearms supported on desk?

  • Feet supported (i.e. feet flat on the floor or consider footrest to ensure knees are level with hips)?

  • Monitor height and angle appropriate for to maintain neutral neck position?

  • Monitor at suitable distance to view easily (i.e. approx. arms length away)?

  • Shoulders relaxed when key boarding, key board legs on lowest setting to avoid extension of the wrists?

  • Mouse is used without stretching/overreaching (i.e. positioned close to keyboard)?

  • If regularly transcribing from documents, documents positioned between the monitor and keyboard to avoid repetitive neck rotation?

  • Frequency of telephone use determined. If computing required when on telephone, consider provision of a headset or using phone on speaker?

  • Commonly used items (i.e. telephone, documents) are within easy reach on desk? <br>

  • Removal of desk clutter. Set-up desk to allow position for computing and position for writing/reading?

  • Work is organised to enable varying work posture and activity at least once every hour.

  • Workstation ergonomics flyer is displayed in the home office?

    Workstation Ergonomics Flyer
  • <br>


  • Insert photo of Workstation set-up:

Workplace Health & Safety (WHS)


  • Are floor surfaces even, free of slips/trips/falls hazards and in good condition?

  • Are office floors, walkways, storerooms and stairways clear of obstacles?

  • Are stairs fitted with a handrail?

  • Area walkways kept clear of open drawers and cupboard doors?

  • Are walkways free of electrical, telephone and computer cables?


  • Provide details:


  • Is the ventilation adequate (i.e. no draughts, or extremes or temperature)?

  • Is lighting adequate for work being performed (i.e. not to dull, no flickering or shadows)?

  • Are light fittings, light bulbs and fluorescent tubes clean and in good working order?

  • Are distracting or disruptive noises in the work area minimised (e.g. photocopiers not to close to workstations)? <br>

  • Is there sufficient space for tasks to be safely carried out?

  • Are the kitchen and bathroom amenities clean and tidy?


  • Provide details:


  • Are storage areas kept clean and tidy?

  • Are any items stored higher than 1800mm?

  • Are items stored securely and not in danger of falling?

  • Are heavy or regularly used items stored between mid thigh & shoulder height?

  • Is there sufficient storage space in the work area?

  • Are filing cabinets stable when ore than one draw is open?

  • Is there sufficient space around storage areas for easy and safe access?

  • Are drawers and cupboards closed when not in use?

  • Are you aware of correct manual handling techniques?


  • Provide details:


  • Is the wiring of electrical appliances in good order (e.g. no damaged, discoloured cords or exposed wires etc.)

  • Are plugs and switches in good working condition?

  • All power sockets and computer connections easily accessible and being used in a safe manner?

  • Are power boards (with surge protector for computer) being used?


  • Provide details:


  • Is there a functional and appropriately stocked first aid kit in the home?

  • Insert photo:

  • Does the home have a functioning smoke detector in place?

  • Does the home have a fire blanket?

  • Insert photo:

  • Are all access and exit points readily accessible and free from obstructions?

  • Is there an Emergency Evacuation Procedure and Emergency Contacts displayed in the home office?

  • Insert photo


  • Provide details:


  • Are you aware of the WHS Team Member for your office?


  • Provide details:



  • Signature

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.