Title Page

  • Name

  • Site conducted

  • Date

  • Prepared by

  • INSTRUCTIONS:
    -------------------------------------
    1. Answer the applicable questions.
    2. Click Add photos and notes.
    3. To add a Corrective Measure click on "Add Action", provide a description, assign to a member, set priority and due date.
    4. Complete audit by providing digital signature.
    5. Share your report by exporting as PDF, Word, Excel or Web Link.

Employee Details

  • Glasses/Contact Lenses

  • Last Eye Test

  • Height

  • Dominant Hand

  • Please select response

  • Do you use more than one computer at work

  • How many

  • Time on computer per day (hours)

  • Do you use a laptop for work

  • Do you work on a computer/laptop at home

Assessor’s Observation/Observed Risk Factors Prior To VDU Assessment

  • Wrists/Forearms resting on edge of workstation

  • Slouched /poor posture

  • Shoulders elevated when typing

  • Hunched forward over keyboard or workstation

  • Feet supported when sitting (floor or footrest)

  • Comment

ASSESSMENT – POST DEMONSTRATION

Chair

  • Chair Type

  • 1 Person has been instructed in chair adjustment and correct sitting posture for computer based work

  • 2 Chair is stable, comfortable & allows easy freedom of movement

  • 3 Seat adjustable in height

  • 4 Backrest adjustable in both height and tilt

  • 5 Chair has a five star castor base

  • 6 Chair can be adjusted for optimal fit/comfort

  • 7 Armrests fitted and are adjustable

  • 8 The person has demonstrated chair adjustment and correct sitting posture for computer based work

  • Photo of the chair

Keyboard

  • 1 Keyboard has a matt surface to avoid reflective glare

  • 2 Characters on the keyboard legible

  • 3 Keyboard is separate from the screen and adjustable in tilt

  • 4 Keyboard sits at an optimal height for keyboarding (e.g. 1- 2 cm below optimal seated elbow height)

  • Comment

Mouse

  • 1 % of time spent on mouse: 50 % 50

  • 2 Mouse located close to the user (so elbow is close to the body)

  • 3 Person can use the mouse keeping the wrist in a neutral posture (fingers in line with the forearm)

  • 4 Sufficient space on the desk for comfortable mouse use.

  • Comment

Display Screen

  • 1 Screen(s) positioned directly in front and arms length from the user

  • 2 Screen free of flickers, damage, ghosting, discoloration with clear sharp characters brightness and contrast adjusted

  • 3 Screen free from reflective glare (Windows, Overhead light, other screens)<br>If in doubt, use a mirror to identify sources of glare.

  • 4 Screen is height adjustable and can swivel & tilt to preferred position

  • 5 How many Screens

  • Comment

Work Postures (Seated)

  • 1 Can the person adopt a neutral work posture when seated

  • 2 Feet resting flat on the floor / foot rest with knees slightly lower than hips

  • 3 Sitting with back pressed firmly up against backrest

  • 4 Visibly space between front edge of seat pan and the back of the knee

  • 5 Keyboard and mouse in primary zone on the workstation with enough space to opperate

  • 6 Wrists in a neutral posture while working

  • 7 Upper arms hanging relaxed at the side of the body, (elbows in by the ribs)

  • Comment

Work Desk/Station

  • 1 Is there adequate space

  • - in front of the keyboard to support your hands and wrists (Forearms not resting on the edge of the workstation)

  • - on your desk surface for your equipment and work. (No clutter or excess paperwork, cables etc. Enough space for safe use of keyboard and mouse)

  • - underneath your desk (user can stretch out and change their leg position while at the workstation)

  • 2 Desk is at a suitable height for the user

  • 3 Can reach frequently used items (primary zone items i.e. phone)

  • 4 Portable cables have up to date PAT stickers

  • Photo of the workstation

Environment

  • 1. Current light levels at the workstation

  • 2. Windows in the room fitted with suitable blinds/covering

  • 3. Work environment free from excessive noise or distractions

  • 4. Work environment free form equipment emitting excessive heat

  • 5. Work area temperature can be adjusted and is comfortable for user

  • Comment

Wellbeing and Health

  • 1. Work planned so that activities can be changed or a break can be taken from intensive screen and keyboard use

  • 2. Person able to cope with their computer work without experiencing undue stress or tension

  • 3. Any discomfort or pain at present,

  • Specify the pain or discomfort

  • Please select response

  • What activities (work or non-work) cause the discomfort to increase

  • What treatment, if any have you received for the pain or discomfort

Other Issues

  • Does the person have any other problems / complaints related to:<br>- Unusual task demands<br>- Multiple screens at the same time<br>- Heavy lifting during the work day (boxes of paper, Water bottles)<br>- Having to reach or twist to get at frequently used items

  • Describe the issues

Completion

  • Referred to

  • Please specify

  • Is there any equipment you require which has come to light following the assessment

  • Assessor

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.