Lumiform
Features Solutions Resources Templates Enterprise Pricing
Select a language
Englishen
Deutschde
Françaisfr
Españoles
Português (BR)pt-BR
en
Log in
Book a demo
Book a demo
Back
Englishen
Deutschde
Françaisfr
Españoles
Português (BR)pt-BR
Features Solutions Resources Templates Enterprise Pricing
Free demo
Log in
en
Book a personal demoView video demoContact sales
Explore
Resource hubCentral repository for all Lumiform resourcesCustomer storiesReal-world successes and experiences with Lumiform.
Learn
Template collectionsComprehensive collections of best practice templates.Topic guidesComprehensive safety, quality, and excellence insights.LexiconDefinitions key to quality, safety, and compliance.
Support
Developer's guideTechnical documentation for developers.Help centerAssistance with onboarding and platform mastery.
Featured reads
Explore our collection of 38 free preventive maintenance checklists

Template collection

Explore our collection of 38 free preventive maintenance checklists

Start reading
Your guide to performing and documenting efficient child care observation

Topic guide

Your guide to performing and documenting efficient child care observation

Start reading
Lumiform as customer journey mapping tool in gastronomy

Success story

Lumiform as customer journey mapping tool in gastronomy

Start reading
Book a personal demoView video demoContact sales
By industry
Food and hospitalityManufacturingConstructionRetailTransport and logisticsFacility managementView all industries
By business needs
Health and safetyQualityOperational excellenceRisk management and complianceView all business needs
By use case
Safety management softwareEnergy audit appForklift inspection appBuilding management softwareVehicle inspection appQMS appKaizen method appProperty inspection appRestaurant inspection appElevator management appProject management softwareFire inspection app
View all app uses
Book a personal demoView video demoContact sales
Overview
Template libraryDiscover over 12,000 free, ready-made and expert proofed templates.
Use cases
CleaningMaintenanceRisk assessmentSupply chainIncident management
Business needs
Health and safety managementQuality managementOperational excellenceRisk management and compliance
Industries
Food and hospitalityManufacturingRetailTransport and logisticsConstructionFacility management
Book a personal demoView video demoContact sales
Overview
Product overviewAll features
Capabilities
Digitize
Form builderMobile AppActions
Automate
Workflow automationApprovalsIntegrations
Transparency and accountability
ReportsAnalytics
Orchestrate
Administration
Book a personal demoView video demoContact sales
Templates
DSE assessment template

DSE assessment template

Use this DSE assessment form to evaluate workstation ergonomics and identify health risks for display screen users.

Use this template with Lumiform

The Lumiform application helps frontline teams uphold internal standards effortlessly.
  • Customize this template or build your own
  • Fill out templates via mobile app
  • Assign and track corrective actions
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF
DSE assessment template

Use this DSE assessment form to evaluate workstation ergonomics and identify health risks for display screen users.

Use this template with Lumiform

The Lumiform application helps frontline teams uphold internal standards effortlessly.
  • Customize this template or build your own
  • Fill out templates via mobile app
  • Assign and track corrective actions
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF

Our DSE assessment template helps you evaluate workstations and identify potential health risks for employees who regularly use display screen equipment. It aids you in complying with the Health and Safety (Display Screen Equipment) Regulations, which require employers to assess and reduce risks for DSE users.

Research shows that more than 50% of office workers experience neck pain, with shoulders and lower back also commonly affected by poor workstation setup. With comprehensive sections covering screens, furniture, input devices, and work environment, this template enables you to quickly identify issues and implement corrective measures before they lead to musculoskeletal disorders or visual fatigue among your team.

Related categories

  • Health and safety management templates
  • General templates
  • Workforce management and HR templates
  • Workplace safety templates
Preview of the template
Personal Information
Name
Department
Location of Workstation
Reason for Assessment
Your Daily Routine
Do you have any problems with your hands, wrists, arms, shoulders, neck or back?
Do you suffer from visual fatigue or headaches?
Screen
Are characters readable?
Is the image free of flickering and movement?
Is the screen free from glares and reflections?
Furniture
Is the large surface large enough for work equipment (monitor, keyboard, documents)?
Are you sitting comfortably? (Suppported by chair, eye-level slightly below DSE screen?)
Is the chair stable?
Do adjustment mechanisms work?
Keyboard & Mouse
Is the keyboard tiltable?
Is there enough space to rest hands in front of keyboard?
Are characters and keys easy to read?
Does the mouse fit comfortably in one hand?
Does the mouse move easily and respond appropriately?
Work Environment
Are levels of light, heat and noise comfortable?
Is the workstation area free from hazards?
Further notes and concerns.
Sign Off
Date & Time
Signature
This template was downloaded 18 times

More templates like this

DSE risk assessment template
DSE risk assessment template
Document screen, seating, and ergonomic risks for each workstation and boost your workplace safety.
Risk assessment templates
DSE workstation assessment checklist template
DSE workstation assessment checklist template
Enhance workstation ergonomics with our DSE assessment checklist template. Identify risks, optimize comfort, and protect your team's health.
Workplace safety templates
DSE self-assessment form template
DSE self-assessment form template
Identify and address ergonomic issues with our DSE self-assessment form to create a comfortable, healthy workspace.
Workplace safety templates
Display screen equipment assessment
Display screen equipment assessment
This template is used to evaluate the ergonomics of the work space and to perform an inspection of the areas where display screens are used.
Maintenance templates
Workplace safety inspection checklist
Workplace safety inspection checklist
Use this checklist to identify hazards, document findings, and assign follow-ups. It’s designed to help you conduct thorough inspections across various areas.
Workplace safety templates
Ergonomic workstation assessment checklist template
Ergonomic workstation assessment checklist template
Checklist to assess the ergonomics of a workstation
Workplace safety templates

Related resources

Access a complete set of resources aimed at maximizing safety, quality, and operational excellence, including detailed guides, related templates, and real-world use cases.

Topic guides

Read in-depth guides covering key topics related to this article.

Workplace safety: Best strategies and practicesHazard communication program: A guide for workplace safetyErgonomics safety: Your essential guide to a thriving workplace
See all topic guides

Template collections

See comprehensive collections of best practice templates related to this topic.

Top 6 free DSE assessment templates5 hazard identification forms for workplace safety12 free JSA templates for safer workplaces
See all template collections

Use cases

Check out how the Lumiform software can be utilized for related use cases.

Workplace safety softwareJob safety analysis softwareOccupational health and safety softwareHealth and safety management system software
See all use cases

Other resources

Explore all the additional resources we offer to assist you in mastering this topic.

10 reasons why workplace safety is important4 ways that workplace safety increases worker productivityHow to write a workplace safety policyHow to perform safety inspections

Frequently asked questions

What actions should you take after completing a DSE assessment?

After identifying issues, prioritize them based on risk level and implement corrective measures promptly. This might include adjusting equipment, providing accessories like footrests or wrist supports, arranging eye tests, or offering ergonomic training. Document all actions taken and schedule follow-up assessments.

How do you assess if a chair is properly adjusted for DSE work?

Check that the user’s feet rest flat on the floor (or on a footrest), knees are at approximately 90 degrees, lower back is supported by the chair’s lumbar support, and arms are parallel to the desk when typing. The chair should be stable and all adjustment mechanisms should work smoothly.

What should you do if an employee reports headaches during DSE assessment?

First, check screen positioning—it should be at eye level and arm’s length away. Assess lighting for glare or reflections on the screen. Evaluate if the user takes regular breaks. Consider recommending an eye test, as headaches can indicate vision problems. Document these concerns in the assessment’s notes section.

How do you assess DSE needs for employees with existing health conditions?

Take extra care to understand their specific requirements by consulting with occupational health professionals if available. Document their condition in the assessment’s notes section, consider reasonable adjustments like specialized equipment, and schedule more frequent follow-up assessments to monitor effectiveness of interventions.


This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.
Lumiform logo
Platform
HomeProductAll featuresPricingEnterpriseTrust and securityCustomer success offeringsDownload the appDemo videos
Solutions
IndustriesFood and hospitalityManufacturingConstructionRetailTransport and logisticsFacility management
Business needsHealth and safetyQualityOperational excellenceRisk management and compliance
Uses cases
Learn
Template collectionsTopic guidesLexiconHelp centerJournalInfographicsVideos
Resources
Lumiform templatesby industryby use caseby business needAll categories
Customer storiesDeveloper APIResource hubIntegrations
Company
AboutJobsLegalBook a demoContact sales
© 2025 LumiformTerms and conditionsPrivacyData processingSitemap
App StoreGoogle play