🏡🖥️Home Working & DSE Risk Assessment Form

📝 Purpose

This form must be completed by any employee working from home either full-time or part-time. It ensures that your working environment is safe, suitable for prolonged computer use, and compliant with Display Screen Equipment (DSE) regulations.

👤Employee Information

Full Name

Job Title/Role

Main Work Location

Home

On-Site

Hybrid

Other

Date of Completion

🪑Section 1: Workstation Setup

Is your workstation free from tripping hazards and clutter?

Is your chair adjustable and supportive for your back?

Is your screen at eye level to avoid neck strain?

Do you use a separate keyboard and mouse (if using a laptop)?

Is there enough lighting to avoid eye strain?

Do you have enough space to work comfortably?

Can you rest your feet flat on the floor or on a footrest?

Do you take regular breaks (at least 5 minutes every hour)?

🏡Section 2: Home Working Conditions

Do you have a designated, quiet area for work?

Is your work area secure for handling sensitive or confidential information?

Do you have a stable internet connection?

Have you received guidance on safe lone/home working?

Are emergency contact procedures in place (e.g. daily check-ins, contact list)?

🧰Section 3: Equipment and Support

Have you been provided with the necessary equipment to work safely (e.g. laptop, headset, riser)?

Do you know how to report a problem with equipment or request adjustments?

Do you know who to contact for technical support?

🗣️Section 4: Additional Comments or/and Concerns

Please list any issues, discomforts, or requests for adjustments below:

✍️Declaration

I confirm that I have completed this Home Working & DSE Risk Assessment truthfully and to the best of my knowledge. I will raise any safety concerns with my line manager and follow guidance for safe home working practices.

Signature

Clear

Date