Self Assessment Form Display Screen Equipment (DSE) Self-Assessment Step 1 of 17 5% This assessment is designed to ensure compliance with The Health and Safety (Display Screen Equipment) Regulations and also an investment by your employer to ensure your comfort and well-being whilst working at your computer. This process is designed to cover all aspects of working with computers and we hope you agree that it is a worthwhile exercise, helping to identify and minimise your risks. Please begin the process by downloading and reading the PDF training document 'Importance of Good Posture'. Name* Email* Enter Email Confirm Email Please confirm you have downloaded, read and understood the training material 'Importance of Good Posture'.* Yes, I confirm I have downloaded, read and understood the training material 'Importance of Good Posture' and I am ready to start the self-assessment Display Screen Equipment Self-Assessment Form : Please ensure you have read the training material 'Importance of Good Posture' BEFORE completing this form. Date*Please enter todays date Training and InformationDo you know who to report to if you are experiencing any issues (health and/or equipment) with your workstation*It is important that you are aware of the correct reporting procedures for any DSE-related issues.YesNoHave you read and understood the training material 'Importance of Good Posture' previously downloaded?*This training material provides information for the recommended posture for computer use. It is vital you have read and understood this information to ensure you can complete an informed self-assessment.YesNo Daily Work RoutinesThis section relates to your daily work routine and your workstation use on a typical day.How many days of the week do you work?*Please give the number of days, ie 3,4,5 etc. Please enter a value between 1 and 7.How many hours a day do you spend working at your computer?*Total hours, not including breaks.Please enter a value between 1 and 24.Do you take breaks away from the screen every hour (5 minutes per hour)?*Any kind of rest from looking at the screen is considered a screen break and you do not necessarily have to move away from your desk to answer yes to this question. Taking regular breaks are recommended to avoid visual fatigue. Varying your tasks, for example, telephone work, paper work etc., will provide breaks from your screen-based work.YesNo HealthDo you suffer any physical or visual discomfort whilst working at your computer?*It is advised that you report any symptoms such as headaches, eye strain, blurred vision, or discomfort to the back, neck, shoulders, arms, wrists, hands, fingers, back and lower limbs.YesNoPlease give details*Give details of your symptoms, including whether they affect your left/right side, symptom type, or anything else you feel is relevant. Have you previously reported your symptoms to your employer?*YesNoHave you sought Medical Advice?*YesNoPlease provide any relevant information.* Eyes and EyesightAre you aware of the company eye care policy?*YesNoHave you had an eyesight test?*YesNoWhen was your last eye test?* PostureAfter reading the training material 'Importance of good Posture', are you aware of the correct posture for DSE use?*YesNoDo you sit face on to the monitor and Keyboard (i.e. not at an angle)?*It is recommended that you sit face on to your screen and keyboard to minimise upper body twisting, improving your overall posture.YesNoDoes your job involve copy typing or extensive referral from paper documentation?*YesNoDo you require a document holder?*It is recommended that you review the position of your documents. Documents placed on the desktop to the side of or in front of your keyboard tends to encourage poor posture. Regular leaning to the side or forwards out of your chair is not recommended. Document holders are designed to minimise leaning forward and twisting of the upper body, and to reduce repeated head and neck movements.YesNo ChairDo you know how to adjust your chair?*It is important that you know how to use the adjustments on your chair, allowing you to adjust the chair to suit your requirements.YesNoIs your chair on a stable 5 wheel castor base?*Castors should not be broken and should allow free movement.YesNoIs the seat height adjustable?*A seat height adjustment should be available to allow you to sit comfortably. It is recommended that your arms adopt a right angle and your knees are slightly lower than your hips. Please make any adjustments that you feel necessary.YesNoIs the backrest height adjustable?*The backrest height should be adjustable to ensure your lumbar curve is sufficiently supported. Please review if your backrest or lumbar support can be adjusted in height and make any adjustment that you feel necessary.YesNoIs the backrest angle adjustable?*The chair backrest should be adjusted in angle to provide sufficient support. Sitting too reclined, or leaning forward away from the backrest, are not recommended. It is advised that you maintain contact with the backrest whilst using your screen, keyboard and mouse. Please make any adjustments you feel necessary.YesNoIs the seat depth comfortable?*Perching on the edge of the seat should be avoided as back support will be lost. This may occur if the seat pan is too deep, causing obstruction to the back of the knees. If the seat pan is too shallow, increased pressure may be applied to the underside of the thighs.YesNoPlease give details* Does your chair have armrests?*YesNoCan the armrests be adjusted comfortably?*Position of armrests may affect your posture. If the collide with the desktop you may not be able to pull in close enough to the desk. This will encourage you to lean forward out of your chair, thereby losing back support. It is also advised that the height of armrests allow the shoulders to adopt a relaxed position.YesNoDo all of the adjustments function correctly?*If the adjustments are not functioning correctly, or if anything is broken on your chair, it is recommended that this is reported.YesNoPlease give details* Have you made any adjustments to your chair during the assessment?*It is important that you are sitting comfortably. Please make any adjustments to your chair that you feel are necessary.YesNoPlease Give Details* Seat Height Backrest Height / Lumbar Support Backrest Angle Armrests Seat Depth Are you sitting comfortably in your chair following the adjustments made?*YesNoDo you consider your chair suitable?* YesNoPlease give details* Do you require a footrest?*If your feet are not fully supported when your chair height is comfortable, a footrest is advised. A footrest may also be useful to improve your overall posture, particularly if you have a tendency to lean forward out of your chair.YesNo Display ScreenAre you using a flat screen monitor/monitors?*YesNoPlease provide number of flat screens in use at your workstation* Is your flat screen/screens at a comfortable viewing distance?*A viewing distance of approximately arms length is a good guide but it must be comfortable for you. Positioning the screen too far back on the desk will encourage leaning forward out of the chair.YesNoIs the flat screen/screens at a comfortable viewing height?*It is recommended that the top line of text is at eye level. This aims to minimise repeated head and neck movements. Your head should not stoop forward or be tilted backwards.YesNoAre you using a laptop at your office-based workstation?*YesNoIs your laptop connected to a flat screen (ie not using the laptop screen for screen reference).*YesNoWhen the laptop is connected to the flat screen monitor, do you use a separate keyboard and mouse (ie not using the laptop keyboard and laptop touch pad mouse)?*Using a separate keyboard and mouse is recommended rather than the using the laptop keyboard and touch pad mouse. YesNoIf your laptop is not connected to a flat screen monitor, is the laptop screen raised, for example, is a laptop stand in use?*Laptop screens used at a low height compromise posture, often resulting in unfavorable posture that increases the risk of muskuloskeletal stress. For prolonged laptop screen use it is recommended that the screen is raised to a more suitable height.YesNoDo you consider the laptop screen height to be comfortable?*YesNoDo you consider the laptop screen height to be comfortable.*YesNoAre all screen images stable and flicker free?*YesNoIs the text clear and easy to read on all screens used?*YesNoIs there a facility to adjust brightness and contrast to suit your preferences on all screens used?*YesNoDo you experience glare or reflection on your screen/screens?*YesNoCan you tilt your screens if necessary?*YesNo KeyboardIs the keyboard stable whilst in use?*YesNoCan you adjust the angle of the keyboard?*It is recommended that keyboards have fold out feet to enable the keyboard to be tilted if required.YesNoAre all key symbols visible and easy to read?*YesNoDo all keys function correctly?*YesNoIs there adequate space in front of the keyboard to support the hands and arms?*It is recommended that forearms are as horizontal as possible and working with bent wrists should be avoided. Resting the whole forearm on the desk will encourage bent wrists, increasing the risk of strain and the desktop should not apply pressure to the underside of your arms and wrists. If these are evident it is recommended you review your chair height as it is likely you are sitting too low. Pushing your keyboard too far back on the desk will encourage you to lean forward away from your chair. Positioning the keyboard too near to the edge of your desk will loose wrist support, encouraging flexing and bending of the wrists.YesNoDo you experience any aches or strains in the hands, wrists or fingers or arms when using the keyboard?*YesNoPlease Give Details:* MouseWhich hand do you use to operate the mouse?*It is advised that the mouse is programmed for the correct hand.LeftRightIs your mouse positioned according to the DSE guidance when in use?*It is recommended that the arm adopts a relaxed right angle with the upper arm close to the side of the body. Reaching forward or out to the side from the shoulder should be avoided. It is advised for the wrist to be straight as an angled wrist will encourage flexing and bending. Pressure from the desktop on the underside of the wrist should also be avoided.YesNoIs there adequate space for your wrist to be supported when using the mouse?*It is recommended that the mouse is not positioned too close to the edge of the desk as wrist support will be lost, encouraging flexing and bending of the wrist. However, remember that the desk should not apply pressure to the underside of the arm/wrist and if this is evident, it is likely you are sitting too low in your chair.YesNoDo you require a mouse mat?*A mouse mat should be free of sharp edges and not apply too much pressure on the underside of the wrist.YesNoDo you experience any aches or strains in the hand, wrist or fingers, arm or shoulder when using the mouse? If yes please provide details*YesNoPlease Give Details* DeskDo you have sufficient desk top space for all workstation tasks?*Desktop space should be sufficient to accommodate all workstation equipment without compromising its layout.YesNoIs the desk height suitable?*When your chair is adjusted to a comfortable height, it is recommended that the desk height is reviewed. Remember it is advised that your arms adopt a right angle when using the keyboard and mouse.YesNoPlease provide further details.* Is there adequate leg room under the desk?*Obstruction under your desk may affect your posture. Cables etc. should not obstruct your feet and there should be sufficient clearance for your knees. It is recommended that feet are positioned centrally, in-line with your keyboard and screen. Twisting the legs/feet is not advised as this will affect your overall posture.YesNoPlease provide details* Do you have adequate storage at your desk?*Excessive material on your desk limits the free desk space and may result in poor positioning of your display screen equipment.YesNoIs there any damage to the desk?*The desk should have no sharp edges, corners, or protruding parts.YesNoPlease give details* Telephone WorkDo you use the telephone and computer at the same time?*It is advised that cradling the handset between the ear and shoulder is avoided. Please consider suitability of using a headset.YesNoDo you require a telephone headset?*YesNo Workstation EnvironmentIs the floor under and around the workstation in good condition?*Please check for damaged carpet/flooring that may present a tripping hazard.YesNoPlease give details* Have all obstructions and tripping hazards been eliminated from the work area?*There should be no trailing cables or storage boxes etc. that are causing obstructions in your walkways.YesNoPlease give details* Do you consider the lighting suitable?*Artificial lighting should be sufficient to allow you to work comfortably but should not cause glare.YesNoPlease give details* Are noise levels in your work area satisfactory?*YesNoPlease give details* Do you consider the office temperature comfortable?*YesNoPlease give details* Are you exposed to fumes whilst working at your workstation?*YesNoPlease give details* Is your workstation and equipment cleaned regularly?*It is recommended that all equipment is regularly cleaned using a cleaning method suitable for computer equipment. It is advised that food and drink are consumed away from your workstation.YesNoDo you require Screen Cleansing Wipes?*YesNo HomeworkingDoes your employer require you to work from home?* YesNoPlease describe the extent and pattern of your homeworking, for example, do you work from home every day for full or partial days, or fewer days/hours a week?* Portable DSE DevicesDo you use a laptop away from your desk, for example in meetings, for business travel or homeworking?* YesNoPlease describe circumstances for laptop use?* When working away from your office-based desk, do you spend prolonged periods using your laptop?* YesNoDo you experience discomfort as a result of working with your laptop?* YesNoPlease provide details?* Do you transport your laptop to/from the office?*It is recommended that a suitable laptop carrier is used and that you only carry what you need to reduce the load.YesNoPlease state how you carry your laptop? For example do you use a backpack or shoulder bag etc?* For work purposes do you use any other portable devices such as tablets or Smartphones?*It is recommended that a suitable laptop carrier is used and that you only carry what you need to reduce the load.YesNoPlease provide further details.* Do you experience discomfort as a result of working with these portable DSE devices?* YesNoPlease provide further details.* Miscellaneous InformationAre there any other matters you wish to raise concerning your workstation? If yes, please give details below. Confirmation*Please tick the box below to confirm that the information recorded on this Self-Assessment Checklist is correct. Yes, all information is correct.