DSE Assessment - Cathodic

Your Information

Name *

First

Last

Date / Time *

Date

Time

Where is your work location? *

Please Upload a Photo of your work location

Click or drag a file to this area to upload.

Is this your primary or secondary work location? *

Primary - Main location
Secondary

Department *

Workstation Details

Laptop or Computer Make, Model & Serial Number *

Monitor 1, Make, Model & Serial Number

Monitor 2, Make, Model & Serial Number

Pre Assessment / General Information

How many hours a day do you spend using Display Screen Equipment? *

Have you ever been diagnosed as suffering from a repetitive strain injury (RSI) or Upper limb disorder such as Carpel Tunnel Syndrome, Bursitis, Tennis Elbow, and Tendonitis or similar? *

Yes
No

Do You Suffer From *

Do you wear corrective spectacles or contact lenses? *

All the time
For Reading
For DSE work
None of the above

When did you last have your eyes tested? *

Withing the last year
1 - 2 Years ago
Over 2 years ago
Never

Do you understand the company's arrangements for DSE eyesight tests? *

How would you describe your work? *

Repetitive
Easy
Complex
Variable

How frequently can you take breaks from work? *

Have you been trained in setting up your workstation? *

Yes
No
Yes, but not at CPC

Screen Information

Does the screen tilt and swivel? *

Yes
No

Can you adjust the brightness and contrast between the on-screen characters and the background? *

Yes
No

Is the screen image stable and free from flicker? *

Yes
No

Is the screen at a height which is comfortable for you? *

Yes
No

Is the screen at a comfortable distance? *

Yes
No

Is your screen free from glare and / or reflections? *

Yes
No

Keyboard

Do you use a keyboard and / or mouse for the majority of your work?

Keyboard
Mouse
Keyboard and Mouse

Is your keyboard separate from your screen? *

Yes
No

Can you raise and lower the keyboard tilt? *

Yes
No

Can you easily see the symbols on your keys? *

Yes
No

Is there enough space to rest your hands in front of your keyboard? *

Yes
No

Seating Arrangements

Is your chair stable? *

Yes
No

Does your chair allow movement? *

Yes
No

Can you adjust the height of your seat? *

Yes
No

Can you adjust the height and angle of your seat back-rest? *

Yes
No

Is your chair in a good state of repair? *

Yes
No

Is your chair comfortable to use? *

Yes
No

Do you have a footrest? *

Yes
No

Can you place your feet on the floor whilst using your keyboard? *

Yes
No

Desk Arrangements

Is the height of your desk suitable? *

Yes
No

Does your desk have a matt (non-reflective) surface? *

Yes
No

Would a document holder be of benefit to you? *

Yes
No

Is your desk surface large enough to allow you to place your equipment where you want it? *

Yes
No

General Environment Arrangements

Covers Lighting, Noise, Space

Describe the lighting situation at your workstation? *

About Right
Too Bright
Too Dark

What control do you have over your local lighting situation? *

Some control
No control

At your workstation, is it usually... *

Too Warm
Too Cool
About Right

Describe the amount of free space around your workstation? *

Sufficient
Not Enough
Unsure

Are you distracted by noise? *

Never
Occasionally
Constantly

Software

Do you have appropriate Software available *

Yes
No

What software do you require?

Do you require any further training in the software you have?

Final Questions

If you had a problem related to DSE work, would you know the correct procedures to follow? *

Yes
No

Are you happy with your workstation layout? *

Yes
No

Are there any other problems associated with your workstation?