WORKSTATION RISK ASSESSMENT FORM

HEALTH AND SAFETY (DISPLAY SCREEN EQUIPMENT)

REGULATIONS 1992

Assessment Form Reference:office use only:
User’s Full Name:
College/Division/Dept/Unit:
Line Manager/Supervisor:
Building & Room Number:
Site:
Date:

WORKSTATION ASSESSMENT CHECKLIST

(PLEASE USE THE GUIDANCE NOTES WHEN COMPLETING THIS FORM)

Risk Factors / Tick answer
Yes / No / Comments
1. HISTORY
Any history of musculo-skeletal disorders including back, neck and wrist pain?
Any problems with vision (e.g. headaches, focusing, reading screen, dry eyes)?
Eyesight test for DSE in the last two years?
Has the user been advised of their entitlement to eyesight testing/eyecare voucher scheme?

Has any Health & Safety training been undertaken?
2. USAGE
Average daily use (hours)?
Left or right handed?
Activities other than using DSE?
3. DISPLAY SCREEN (monitor)
Are the characters clear and readable?
Is the screen’s specification suitable for its intended use?
Is the text size comfortable to read?
Are the brightness and/or contrast adjustable?
Does the screen swivel and tilt?
Is the screen free from glare and reflections?
Is the user facing the screen?
Are adjustable window coverings provided and in an adequate condition (e.g. blinds)?
4. KEYBOARD
Does the keyboard tilt?
Are the characters on the keys easy to read?
Is there support for the user’s hands / forearms infront of the keyboard?
Is the user a touch typist
(i.e. not a‘hunt and pecker’)?
5. MOUSE, TRACKBALL, MAT
Is the device positioned close to the user?
Does the device work smoothly at a speed that suits the user?
6. CHAIR
Is the chair suitable for the user i.e:-
Does the chair have a working:
• back height and tilt adjustment?
• lumbar support?
• seat height adjustment so that forearms
can be positioned horizontal to keyboard?
• swivel mechanism?
7. DESK
Is the work surface large enough for all necessary equipment, papers etc?
Are surfaces free from glare and reflection?
Is there adequate leg room?
Can both feet be placed flat on the floor?
8. ENVIRONMENT
Is there enough room to change position and vary movement?
Is the lighting suitable, e.g. not too bright
or too dim to work comfortably?
Are levels of heat comfortable?
Does the air feel comfortable?
Are levels of noise comfortable?

Assessor’s Comments and Recommendations

TO BE COMPLETED BY THE HEALTH & SAFETY OFFICE OR OCCUPATIONAL HEALTH SERVICE

Assessor’s Name: / Assessor’s Signature:

College/Division / Line Manager/Unit Safety Officer / Administrator:

Action(s) Taken: / Date:
Signature: / Date:

On completion of the section above please file the assessment form in a readily accessible place in your Department / Division / College.

It may be required for future internal or external inspections.

Contacts:

Aurelia Trollope

University Health & Safety Office

Queen’s Building

The Queen’s Drive

Exeter EX4 4QH

Tel: 01392 725340

Email:

Occupational Health Service
Queen's Building
The Queen's Drive
Exeter EX4 4QH

Tel:01392 263136

01392 725792

01392 725025

Email: