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1. Employee Information: Basic details including employee name, department, workstation location, and date of assessment
2. Assessment Context: Type of assessment (initial/follow-up), reason for assessment, hours spent at workstation
3. Workstation Equipment Checklist: Detailed checklist of all equipment present at the workstation (chair, desk, monitor, keyboard, mouse, etc.)
4. Seating Assessment: Evaluation of chair adjustability, settings, and ergonomic positioning
5. Display Screen Setup: Assessment of monitor position, height, distance, and screen settings
6. Input Devices: Evaluation of keyboard and mouse positioning and usage
7. Environmental Factors: Assessment of lighting, noise, temperature, and ventilation
8. Work Habits: Review of work patterns, breaks, and task variation
9. Current Symptoms: Recording of any existing discomfort or symptoms reported by the employee
10. Risk Evaluation: Overall risk rating and immediate concerns identified
11. Actions Required: List of recommended adjustments, equipment needs, or behavioral changes
12. Sign-off: Signatures from assessor, employee, and relevant supervisor/manager
1. Specialized Equipment Assessment: For workstations with specialized equipment or tools beyond standard office setup
2. Disability Considerations: Additional assessment criteria for employees with specific needs or disabilities
3. Remote Work Environment: Specific considerations for assessing home office or remote working setups
4. Previous Assessment History: Summary of past assessments and implemented changes
5. Photos/Diagrams: Section for including visual documentation of the workstation setup
6. Cost Estimates: Estimated costs for recommended equipment or modifications
1. Appendix A: Ergonomic Setup Guide: Visual guide showing correct posture and equipment positioning
2. Appendix B: Risk Rating Matrix: Matrix for determining overall risk levels based on assessment findings
3. Appendix C: Equipment Specifications: Reference guide for recommended equipment specifications and adjustments
4. Appendix D: Exercise Guide: Recommended stretches and exercises for workplace health
5. Appendix E: Relevant Legislation: Summary of key legislative requirements and standards
6. Appendix F: Follow-up Timeline: Recommended timeframes for review and follow-up assessments
Information Technology
Financial Services
Professional Services
Public Sector
Healthcare Administration
Education
Legal Services
Insurance
Telecommunications
Media and Communications
Manufacturing (Office Staff)
Retail (Administrative Functions)
Non-profit Organizations
Research and Development
Customer Service Centers
Health and Safety
Human Resources
Facilities Management
Operations
Risk Management
Compliance
Employee Relations
Workplace Services
Occupational Health
Administrative Services
Health and Safety Manager
HR Manager
Occupational Health Nurse
Ergonomist
Facilities Manager
Office Manager
Risk Assessment Officer
Workplace Safety Coordinator
HR Business Partner
Operations Manager
Team Leader
Department Supervisor
Compliance Officer
Employee Relations Manager
Workplace Wellness Coordinator
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