Working From Home OH&S Checklist

Swinburne Online has a duty of care to provide a safe and healthy work place for all employees under the Occupational Health and Safety Act 2004.

Please complete the Work from Home (WFH) signoff and checklist below and return to Human Resources.

Employeedetails
Name
WFHstreet address
Suburb / State / Country / Postcode
WFH office phone / ) / Mobile / Fax / ) / E-mail
Working From Homeagreement details
Commencement date of Training or Teaching Period / / /
Approximate number of hours of work per week to be worked from home
Checklist
I have reviewed my home worksite and completed and attached the WFH Checklist / Yes / No
Declaration
I have read and understood my Working From Home responsibilities as listed in my Employment Agreement, WFH policy, the WFH Booklet and Checklist. I indicate my acceptance of these responsibilities by signing below.
Employee’s signature / Date / / / HR representative’s signature / Date / /

Please return all documents to: Human Resources

Swinburne Online

Level 1, 541 St Kilda Road

Melbourne VIC 3004

Tick  as appropriate

Workstation
Do you have a separate, designated home work space to undertake your role? / Yes / No
Is your home worksite adequate for the tasks to be performed? / Yes / No
Is your work surface a flat, single, unbroken surface? / Yes / No
Have you a footrest, mouse wrist rest and keyboard wrist restavailable if you need them? / Yes / No
Chair
Do you have a fully adjustable ergonomicchair with a suitable backrest? / Yes / No
Computer, Screen, Keyboard
If you use a laptop or notebook, do you have a separate mouse and keyboard or docking station? / Yes / No
Are your screen, keyboard and mouse appropriately adjusted to maximise comfort? / Yes / No
Is your computer screen at right angles to any windows? / Yes / No
Have you adequate space to use the keyboard in front of the screen? / Yes / No
Mouse
When you use your mouse, is it at the same height as your keyboard? / Yes / No
Environment
Does your home worksite have appropriate light to give even illumination and reduce glare? / Yes / No
Can you control the level of glare with window coverings? / Yes / No
Have you heating and cooling available as required, to make sure the room temperature is comfortable? / Yes / No
Other considerations
Is the floor of your home work space free from tripping hazards? / Yes / No
Is yourcomputerprotected by a earth leakage circuit breaker? / Yes / No
Have you sufficient power outlets to run your computer and any other equipment as necessary? / Yes / No
Have you checked all electrical leads, power boards etc and found them to be in good condition? / Yes / No
Have you a functioning and maintained smoke detector in the house that has been checked within the last six months? / Yes / No
Are you aware of your responsibility to immediately report any accidents or serious incidents to your Program Director or HR? / Yes / No
OHS Issues or Hazards
Are there any OH&S issues or hazards that you are aware of that may affect your ability to work safely from home? If YES, please list below / Yes / No
Declaration
I understand and agree that the work space will be defined as the immediate desk area that is set up to complete work for Swinburne Online Yes No
I understand and agree that once I move away from the work space (immediate desk area) that I am no longer within the working environment Yes No
I have completed this checklist on my designated work space using the document WFH Booklet as a guide. This completed checklist provided is a true and correct account of my home based work space. I understand that if Swinburne Online has reasonable concerns about the compliance of my home based work space that an independent ergonomic assessment of my home based work space may occur at the discretion of Swinburne Online.
Employee’s signature / Date / / / HR representative’s signature / Date / /

Further information and assistance

Adherence to the WFH policy will generally ensure compliance with Swinburne Online requirements and OH&S legislation. However, there may be instances where inadvertent breaches could occur. If you are in doubt or wish to report an incident, you should contact one of the below:

Valerie Efstathiou

Human Resources

(03) 8306 0867

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