Assessment Form
Name of employee
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Job Description (tasks to be done)
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Name of Assessor
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Section A (Computer Screen)
All questions in this section are to be answered by either Y to mean yes or N to mean no
- Are the characters on the screen well defined?
- Is the contrast and brightness of your computer screen adjustable?
- Can the computer screen you use be swiveled or tilted swiftly as per your preferences?
Section B (Workstation)
All questions in this section are to be answered by either Y to mean yes or N to mean no except for the second part of question (m)
- Has the firm provided an adjustable table for your screens?
- Do the keyboards you use have a matt surface?
- Are the characters and symbols on the keyboard you use well contrasted and legible?
- Are the key individual keys on the keyboard easy to press?
- Can you tilt the keyboard you use to suit your preferences?
- Is the space in front of your keyboard sufficient for you to move your hands?
- Is the space on your working desk sufficient for our requirements?
- Is your document holder positioned well?
- Is their adequate space below you to move your legs and assume different postures?
- Does your chair allow you freedom of movement?
- Can the height of the chair you use adjustable?
- Does the chair you use have a footrest? If Yes, if the footrest placed at a point that is good for your height?
- Is your workstation lit optimally? If No, is the lighting excess or inadequate?
- Is your workstation humid enough?
- Are you able to control the humidity and lighting conditions in your working area?
Section C (Recent DSE-associated Health Outcomes)
All questions in this section are to be answered by either Y to mean yes or N to mean no
- Have you experienced any new neck, lower-back or upper limb pains since you started working here?
- Have you felt excessively fatigued mentally after work?
- Have you felt excessively fatigued physically after work? Mention any other accompanying symptoms……………………………………………………………………
- Have you experienced any new visual symptoms since you started working here? If Yes, explain briefly ……………………………………………………………………………………
