close
lumiform
Lumiform Mobile audits & inspections
Get App Get App

DSE Workstation Assessment Form Template

This template is used to evaluate the ergonomics of the work space and to perform an inspection of the areas where Display Screen Equipment (DSE) is used.

Take charge of your work environment, ensure healthy surroundings and benefit from a more productive workforce that stays healthy and motivated in optimal surroundings with our free template.
Rated 5/5 stars on Capterra

Say goodbye to paper checklists!

Lumiform enables you to conduct digital inspections via app easier than ever before
  • Cut inspection time by 50%
  • Uncover more issues and solve them 4x faster
  • Select from over 5,000 expert-proofed templates

Digitalize this paper form now

Register for free on lumiformapp.com and conduct inspections via our mobile app

  • Cut inspection time by 50%
  • Uncover more issues and solve them 4x faster
  • Select from over 4000 expert-proofed templates
Rated 5/5 stars on Capterra

DSE Workstation Assessment Form Template

Audit

Employee Details:

Name:

Contact information including telephone and email address:

Working status? I.e Full Time? Part Time? Contractor?

Employed? Self employed?

For Assessor/Line Manager to complete:

Workstation location and number (if applicable)?

Assessor name?

Checklist completed by?

Date of assessment?

Line manager name and contact details?

Assessment checked by?

Any further action needed?

Follow up action completed on?

MAIN ASSESSMENT QUESTIONS

Display Screens

Are the characters clear and readable?

Is the text size comfortable to read?

Is the image stable? I.e is free of flicker?

Is the screens specification suitable for its intended use?

Are the brightness and/or contrast adjustable?

Does the screen swivel and tilt?

Is the screen free from glare and reflections?

Are adjustable window coverings provided and in adequate condition?

Are adjustable window coverings provided and in adequate condition ?

Keyboards

Is the keyboard separate from the screen?

Does the keyboard tilt?

Is it possible to find a comfortable keying position?

Do you have good keyboard technique?

Are the characters on the keys easily readible?

Mouse, pointing device

Is the device suitable for the tasks it is used for?

Is the device positioned close to you?

Is there support for your wrist and forearm?

Does the device work smoothly at a speed that suits you?

Can you easily adjust software settings and accuracy of the pointer?

Software

Is the software suitable for the task?

Furniture

Is the work surface large enough for all the necessary equipment and papers etc?

Can you comfortably reach all of the equipment and papers you need to use?

Are surfaces free from glare and reflection?

Is the chair suitable and stable? Does the chair have a working:

Seat back height and tilt adjustment?

Seat height adjustment?

Swivel mechanism?

Castors?

Glides?

Is the chair adjusted correctly?

Is the small of the back supported by the chairs backrest?

Are forearms horizontal and eyes roughly the same height as the VDU?

Is the seat depth adjustable to allow a gap of approx. 2 fingers between the back of the knees and front of the seat?

Are feet flat on the floor or foot rest, without too much pressure from the seat on the backs of the legs ?

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?

Does the air feel comfortable?

Are levels of heat comfortable?

Are the levels of noise comfortable?

Final questions

If you have other problems with your VDU workstation that are not addresses above then please mention them here.

Have you experienced any discomfort or other symptoms which you attribute to working with the VDU? Please list details here:

A you aware of your entitlement to eye and eyesight testing?

Do you ensure that you take regular breaks away from DSE's?

Do you experience any ill health, that you feel is attributed to the use of the DSE? If so it may indicate that reassessment is required. Highlight this to your Health and Safety Coordinator who will arrange for a reassessment to be undertaken.

Assessor findings and recommendations:

(check name not set)

Share this template:

Similiar templates