Working From Home

• Conducted on

  Date

• Prepared by

• Location
  Address

• Is the use of DSE a requirement of your work on a daily basis?

  Yes

  No

  N/A

• Do you use the DSE for continuous or near continuous spells of an hour or more at a time?

  Yes

  No

  N/A

• Does the majority of your display screen work involve the use of a stand-alone portable laptop computer?

  Yes

  No

  N/A

Screen

• Is the screen located in front of you when using the equipment?

  Yes

  No

  N/A

• Is the top of the screen level with your eye level?

  Yes

  No

  N/A

• Can the screen be tilted and adjusted to a comfortable position?

  Yes

  No

  N/A

• Can the screen be made free of reflections from windows, overhead lighting, etc?

  Yes

  No

  N/A

• Please provide photographic evidence of the location of your screen and your work desk surroundings

  Media

Keyboard and Mouse

• Can the keyboard be moved to a comfortable position in front of you?

  Yes

  No

  N/A

• Is there sufficient room in front of the keyboard to rest your wrists when not using the keyboard?

  Yes

  No

  N/A

• Are the keyboard symbols clear and legible?

  Yes

  No

  N/A

• Can you operate the mouse or trackball without reaching?

  Yes

  No

  N/A

• Can you operate the mouse or trackball with your hand and wrist resting on the desk?

  Yes

  No

  N/A

• Is there adequate space to manoeuvre the mouse?

  Yes

  No

  N/A

• Please share a photo of your work station as it would be whilst you are working.

  Media

Chair

• Is the height of the chair adjustable?

  Yes

  No

  N/A

• Is the backrest adjustable for height and tilt?

  Yes

  No

  N/A

• Do you know how to adjust the height of the chair and or the backrest?

  Yes

  No

  N/A

• Is the chair fitted with arms?

  Yes

  No

  N/A

• If YES: When the chair is correctly adjusted do the arms of the chair come into contact with the desk? See section on Posture.

  Yes

  No

  N/A

• Please share photos of your work chair in your working position.

  Media

Desk

• Is there adequate work surface to allow a flexible arrangement for the screen, keyboard and mouse operation?

  Yes

  No

  N/A

• Is there adequate knee room to obtain a comfortable position?

  Yes

  No

  N/A

General

• Is there adequate lighting?

  Yes

  No

  N/A

• Is there adequate humidity in the atmosphere?

  Yes

  No

  N/A

• Is the work arranged so that there are breaks away from the DSE?

  Yes

  No

  N/A

Posture

• When positioned to use the keyboard are your upper arms in line with your upper body?

  Yes

  No

  N/A

• With your fingers on the keys are your wrists straight?

  Yes

  No

  N/A

• When in this position is your back supported by the chair’s backrest?

  Yes

  No

  N/A

• When in this position do your feet rest comfortably on the floor without the seat digging into the back of your knees or thighs?

  Yes

  No

  N/A

Eye test

• Have you had your eyes tested for use with DSE?

  Yes

  No

  N/A

Personal

• Do you suffer from work related aches or pains in your: <br>Wrists<br>Forearms <br>Neck <br>Eyes<br>back

  Yes

  No

• Please Exlpain

• Have you ever suffered from epilepsy?

  Yes

  No

  N/A