Display Screen Equipment (DSE)

Assessment Template

This DSE self-assessment is undertaken in accordance with the Health and Safety (Display Screen Equipment) Regulations and is only to be
completed by employees who are Defined DSE Users. DSE User is someone who habitually uses DSE as a significant part of their normal
work.

If you are currently experiencing ill-health symptoms, which you associate with the use of DSE, please speak to your manager.
Once section 1 of this form has been completed, please sign and date and give to your manager to complete and sign. Your manager will
retain a copy for their records on your personal file and give you a copy.
Name of Employee

Designation

Department

Date of Assessment

Site and Location

DSE User should complete this section and can seek assistance from their manager if required. Please tick Yes, No or Not Applicable for each
question. If you answer No to any questions, please take the action as described. Please complete this for your normal workstation

Section 1

Prepared by: Engr. Mohsin www.hsefiles.com

 Display Screen Equipment (DSE)
Assessment Template

Display Screen
Criteria Yes/No/NA Action to take

Is the screen set squarely in front of you? Please adjust the position of the screen accordingly.
Is the screen set at the right height and tilt for your typing skill/eye-
Please adjust the position of the screen accordingly.
line?
Swivel and tilt may not be built in but it can be arranged
Does the screen swivel and tilt and adjust in height? if required for your needs e.g., monitor arm. Please
notify your manager if it is not available and needed.
Please identify the source of glare/reflection. If
necessary and you are able to; move the screen without
Is the screen free from glare and reflection?
affecting the correct workstation position. If you still
unable to resolve this issue please notify your manager.
Try using different screen colors to reduce flicker
Is the image stable i.e., free from flicker?
e.g., darker background and lighter text.
Software settings may need adjusting to change text
Is the text size comfortable to read?
size.
Small detailed work requires larger display screens.
Is the screen’s specification suitable for its intended use?
Please notify your manager to discuss.

Are the brightness and contrast adjustable? Facilities to adjust should be provided within the screen.

Keyboard
Criteria Yes/No/NA Action to take

Is the keyboard set squarely in front of you? Please adjust the position of the keyboard accordingly.

This is a requirement unless the task makes it

Is the keyboard separate from the screen? (This also applies if you
impractical e.g., for infrequent ad-hoc tasks or where
use a laptop as your normal DSE.)
you may use your laptop for short periods.
Please note that tilt does not need to be built in.
Does the keyboard tilt? However, if it is required to achieve a comfortable
keying position for you then notify your line manager.
Keyboards should be kept clean. If characters still cannot
Are the characters clear and readable?
be read, the keyboard may need modifying or replacing.

Mouse
Criteria Yes/No/NA Action to take

Is the mouse positioned close to you? (e.g., right beside the Please re-arrange your workspace to allow for sufficient
keyboard) space to move it close by you.

See if the device needs cleaning. You can adjust

Does the device work smoothly and at a speed that suits you?
your mouse setting under control panel.

Please re-arrange the workstation to allow sufficient

Is there support for your wrists and forearms (e.g., desk surface)
space

Furniture

Criteria Yes/No/NA Action to take

Prepared by: Engr. Mohsin www.hsefiles.com

 Display Screen Equipment (DSE)
Assessment Template

Please remove all obstructions from underneath the

Is there sufficient space beneath your desk for your legs?
desk.
Please create more room by moving materials
Is the work surface large enough for all the work equipment?
elsewhere.
Please notify your manager if you cannot resolve this
Are the surfaces free from glare and reflection?
yourself.
Please move the keyboard forward to allow enough
Is there sufficient space in front of the keyboard for your hands?
space.
Chair

Criteria Yes/No/NA Action to take

Is the chair stable? Please notify your manager.

Is the base a 5-star configuration on castors that move freely? Please notify your manager.

Is the small of the back supported by the chairs’ back (e.g., it has Please adjust as required. If you cannot adjust to the
lumbar support) correct position, please notify your manager.
Please adjust as required. If you cannot adjust to the
Is the chair seat height adjustable?
correct position, please notify your manager.
Is the back adjustable for height and tilt? (These adjustments
Please adjust as required. If you cannot adjust to the
should be available on your chair but how to adjust will vary from
correct position, please notify your manager.
chair to chair)
Armrests are not essential but if you cannot adjust those
If your chair has armrests, do they adjust in height? fitted to the chair to the correct position, please notify
your manager
Is the seat pan depth satisfactory in the correct sitting position?
Please adjust as required. If you cannot adjust to the
(The distance between the front edge of your chair and the back of
correct position, please notify your manager.
your knee should be not be more that the width of your hand)

Work Activity

Criteria Yes/No/NA Action to take

Do you vary your work and take regular breaks away from your
workstation? e.g., micro break
Are you aware as a defined DSE user you are entitled to an
eyesight test?

Software

Criteria Yes/No/NA Action to take

Is the software suitable for the tasks you undertake? (Excel, word,
Please notify your manager.
Google mail)

Have you received appropriate training in the use of the software? Please notify your manager.

Environment

Criteria Yes/No/NA Action to take

Prepared by: Engr. Mohsin www.hsefiles.com

 Display Screen Equipment (DSE)
Assessment Template

Is there sufficient natural or artificial light at the workstation? (This If you have concerns about lighting levels at the
includes additional lighting e.g., desk lamps, if necessary) workstation, please notify your manager.
Are the windows fitted with a system to limit the effects of If you have concerns about reflections/glare at the
reflection and glare? (e.g., blinds/curtains) workstation, please notify your manager.
Are cables routed safely to prevent a tripping or electrical hazard? Please notify your manager.

Is there enough room to change position and vary movement? Please notify your manager.

Overall

Criteria Yes/No/NA Action to take

Are your feet on the floor without too much pressure from the seat Please notify your manager as a footrest may be
on the back of the legs? required.
When your chair is adjusted correctly does the desk height cause
Please notify your manager.
you any issues? (e.g., knees touching desk bent back)
Other
Do you have any other issues associated with working with DSE that are not covered in this assessment?
Please list these issues here and raise with your manager.






Employee Signature: ________________________ Date: _____________________________________

Section 2
Actions to be taken by manager
The manager must complete this section. Please detail the actions to be taken when “No” has been answered in section 1.
Action Date Taken Status
1.

2.

3.

4.

Manager Signature: ________________________ Date: _____________________________________

A copy of this report with manager action has been sent to employee for information □ Yes □ No

Prepared by: Engr. Mohsin www.hsefiles.com