DSE assessment form

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					                      Workstation Risk Assessment – Display Screen Equipment
 Name:                                                          Job Title:
                                                                Tel number:
 Name of line manager:                                          Workstation location:

 Date viewed ‘DSE Safely’ presentation:                         Date Questionnaire completed:

If you have more than one workstation, please answer these questions in relation to the one you use
most often.
                                       DSE User complete this If          further       assessment
                                       section                     necessary      DSE     Assessor
                                                                   complete this section
  1. Work Task Information                   Comments              Comments               Priority
                                                       Y/N                                      H/M/L
 Do you use the computer on a daily basis?

 Do you use the computer continuously for periods
 greater than one hour?
 Are you able to vary between mouse and keyboard
 use to navigate/input data?
 Are you able to pace your work on the computer?

 Are you able to vary your type of work activity
 during the day? E.g. filing, phone calls etc.
 Do you have regular breaks from DSE work?

 Is the software easy to use and understand?

 2. Postural/Visual Comfort Screen
 Can the screen be swivelled and tilted?

 Can the screen be positioned at a height to suit
 your requirements?
 Is the screen free from glare or reflections?

 Can you adjust the brightness and contrast
 Are the characters easily readable?

 Can you position documents where they can be
 seen easily?
 Would a document holder be useful?

 Is the keyboard separate from the screen?

 Can you move the keyboard so as to get a
 comfortable position?
 Can you tilt the keyboard?

 Is there sufficient space in front of your keyboard
 to rest your hands/arms occasionally?
 Do you use a wrist rest when using the keyboard?

 If no to the above question, do you require a wrist

     Dec 2008                                            Page 1 of 4
Are the characters on the keyboard legible?

Work desk/work surface
Is your workstation stable and in good order?

Is there adequate clearance for your thighs, knees,
lower legs and feet under the work surface?
Is the work surface non-reflective?

Is there enough space on the desk to allow for the
optimum positioning of equipment?

Do you know how to adjust your chair?

Does your chair have a five star base and height
adjustable seat?
Can you adjust the height of your lumbar support
as well as your backrest angle?
Can you comfortably place your feet on the floor
whilst seated?
If not do you require a footrest?

Can you easily move the chair and is it stable?

Is it possible to move the chair close to the desk?

3. Environment
Is there adequate contrast between the level of
lighting in the room and the screen?
Would you rate the general level of lighting as
Is your work area free from reflections and glare?

Can you work without being distracted by the noise
of office equipment?
Would you rate the temperature             at   your
workstation as comfortable?
Would you rate the humidity level at your
workstation as comfortable?
Would you rate the level of ventilation as

4. The Individual
Do you understand how to use the software?

Have you received training on the use of the
Have you been informed as to the availability of
free eye tests for DSE use?

5. General
Do you suffer from any postural or visual
discomfort or pains associated with DSE use?
Do you have any particular medical issues related
to DSE use?
User - Additional comments to clarify any points made above or to raise any other related issues. Use a separate sheet if necessary.

Please copy this form to your line manager so that any further action can be taken.
To the line manager ensure that action is taken:
 Ensure any necessary equipment (e.g. foot rest/document holder) is provided
 Contact local DSE assessor if more detailed assessment necessary i.e. if there are any no responses in sections 1-4 and/or yes
  responses in section 5
 Contact your Local Health and Safety Advisor if advice needed for special medical needs
Date actioned by line manager:

    Dec 2008                                             Page 2 of 4
Appendix 1: DSE Assessor Corrective Actions Form

Only print this page if a DSE Assessor has done an assessment.

To be completed by the DSE Assessor.

Name of DSE Assessor
Name of Individual being Assessed

Summary of risks:

Describe corrective actions needed     Priority    Person        Target Date   Completion
                                                   Responsible                 Date

Dec 2008                             Page 3 of 4
Appendix 2: Assessment Register

Register of Employees seen By DSE Assessor

Workplace Area/Location: __________________

DSE Assessor: ___________________

 Employee Name       Job title       Date      Corrective actions    Review   Assessor
                      Team /       assessed         Yes/No            date    signature
                     Function                   (see assessment
                                               record for details)

Dec 2008                         Page 4 of 4

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