Display Screen Equipment Self Assessment
The purpose of this form is for you to assess how your workstation is set up and whether there are any adjustments that need to be made to enable you to work comfortably. You should be able to make adjustments to your workstation as you complete this form, but please highlight any areas that you can't adjust. A copy of the completed form will be sent to the health and safety team who will discuss any relevant changes with you and your line manager
Full Name
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First Name
Last Name
Job Title
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Department
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Location
e.g home, marketing office, SB
Date Form Completed
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Day
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Month
Year
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Display Screen Set Up
This image demonstrates good practice for setting up and using your workstation. We are all built differently so your set up might vary slightly.
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Screen/Display
This section is all about your screen and how it is working and set up
Are the characters on the screen clear and readable?
Yes
No
Is the text size comfortable to read?
Yes
No
Are the brightness and/or contrast adjustable?
Yes
No
Does the screen swivel and tilt?
Yes
No
Is the screen at a comfortable height for you?
Yes
No
Is the screen free from glare and reflections?
Yes
No
Please add any relevant information or comments about your screen/display
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Keyboard & Mouse
This section is about how your keyboard and mouse are set up. You might need to make some adjustments as you work through the questions
Does the keyboard have the ability to tilt?
Yes
No
Is the typing position comfortable
Yes
No
Is the keyboard placed directly in front of you in a position that avoids you reaching out to it?
Yes
No
Is the mouse suitable for the tasks it is used for?
Yes
No
Is the mouse positioned close enough to you?
Yes
No
Please add any relevant information or comments about your keyboard or mouse
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Desk and Chair
In this section we will look at your desk and chair and your posture. Again you might want to make some alrerations to the set up of the workstation as you go through this section
Is the work surface large enough for all the necessary equipment?
Yes
No
Is the chair stable?
Yes
No
Does the chair have seat back height and tilt adjustment?
Yes
No
Does the chair have seat height adjustment?
Yes
No
Does the chair have swivel mechanism?
Yes
No
Does the chair have castors or glides?
Yes
No
Are forearms horizontal and eyes at roughly the same height as the top of the screen?
Yes
No
Is the lower back supported by the chair’s backrest?
Yes
No
Please add any relevant information or comments about your desk or chair
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Environment
In this section we there are some questions about the location you work in your environment
Is there enough room for you to change position and vary movement?
Yes
No
Is the lighting suitable, e.g. not too bright or too dim to work comfortably?
Yes
No
Are levels of heat and ventilation satisfactory?
Yes
No
Are levels of noise in the vicinity of the workstation satisfactory?
Yes
No
Please add any relevant information or comments about your working environment
Would you like to book an appointment to have the Health and Safety Team assess your workstation?
Please Select
Yes
No
Submit
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Health and Safety Dept. Comments
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