Occupational Health and Safety Checklist

The Occupational Health and Safety Checklist is designed to help employees and managers
assess OHS risks in the home office or telework location. This guide was prepared
referencing the NSW WorkCover Authority pulication! Health and Safety in the Office Guide
2004. However it is not an e"haustive list and it is strongly recommended that an inspection
of the off#site location.
A copy of the completed checklist should e retained on the employee$s personnel file with
the work agreement.
Work Environment Ye
s
No
Designated Work Area
A work area has een identified of at least %.&' s(uare metres of unencumered
space

The work floor is level and there is limited use of mats)or rugs

Environmental Conditions
*ighting is ade(uate for the tasks eing performed. +asy to see and comfortale on
the eyes

,lare and reflection can e controlled

-entilation and room temperature can e controlled! regardless of season

There is no e"cessive noise affecting the work area

Walkways are clear of clutter and trip ha.ards

Non smoking environment

Emergency Exit
/ath to the e"it is reasonaly direct

/ath to the e"it is sufficiently wide and free of ostructions or trip ha.ards to allow
unimpeded passage

Security
Security is sufficient to prevent unauthorised entry

A communications procedure has een estalished to ensure regular contact
etween employee and manager

The work area can e secured independently

Electrical
/ower outlets are not overloaded with doule adapters and power oards

+arth leakage circuit protection is in place for work related e(uipment

+lectrical cords are safely stowed

Connectors! plugs and outlet sockets are in a safe condition

+lectrical e(uipment free from any ovious e"ternal damage

Occupational Health and Safety Checklist 0
Occupational Health and Safety Checklist &
Workstation Set Up Yes No
Work Surface
The area of the work surface is at least 0'11mm 2width3 " 411mm 2depth3

The height of the work surface is %51 mm # 6&1 mm aove floor level

There is at least 511mm 2width3 " ''1mm 2depth3 of leg space under the workstation

The work surface is a single continuous surface

A footrest is availale if needed

The most fre(uently used items are within easy reach from the seated position

Cales are stowed out of the way

There are no sharp contact points on the workstation or other e(uipment

Chair
The seat height! seat tilt! angle and ack rest are all ad7ustale

The chair has a five star ase

The chair moves freely

There is ade(uate lumar support

The padding is ade(uate

The chair height is ad7usted so that feet are flat on the floor and knees are ent at
right angles with thighs parallel to the floor

The seat ack is ad7usted to support the lumar curve of the low ack

The seat pan tilt is ad7usted so that hips and tops of thighs are at right angles or
slightly greater

The arm rests can e stowed whilst typing! ut may provide support during other
activities

ey!oard and "ouse
8eyoard to user distance allows user to rela" shoulders with elows close to the
ody

8eyoard position is flat

9ouse is placed directly ne"t to the keyoard

9ouse is at same level as the keyoard

"onitor
9onitor height is ad7usted so top of the screen is at slightly lower height than eye
level

-iewing distance is etween :'1mm # 6'1mm

9onitor and keyoard are placed directly and symmetrically in front of user

9onitor is positioned to avoid glare! i.e. perpendicular to window or other strong light
source

Occupational Health and Safety Checklist :
Nature of #asks Ye
s
No
$hysical Demands of #asks
Safe posture is adopted

Any lifting! pushing or carrying type task is well within physical capacity

Work $ractices
Wrists are kept straight and not supported on any surface while typing

Sitting posture is upright or slightly reclined! with lower ack supported

The telephone is within easy reach from the seated position

*ong periods of continuous activity are roken y performing other tasks!
changing position! standing up and stretching

%ther &actors Ye
s
No
%ther
Telephone or other communication devices are readily availale to allow
effective communication in an emergency situation

+mergency contact numers and details are know

Type C ;irst Aid 8it is supplied and availale

Smoke detector is installed in)near the work and is properly maintained

A process in place for the prompt reporting of incidents

'ndividual factors
Any dependent people have care arrangements in place

The employee$s fitness and health is suitale to the tasks to e undertaken

Any special needs to ensure health and safety have een advised to the
manager

($lease delete paragraph if not re)uired*
The home office or telework location has een inspected and meets the re)uirements of
the <Insert Department Name> <Insert policy name e.. !or"in from Home #olicy $NS!
Sector !or"in %rom Home &inimum Standards>
Signed
Name ($lease
print*
$osition
%rganisation
Date
Occupational Health and Safety Checklist <
Occupational Health and Safety Checklist '
($lease delete paragraph if not re)uired*
The home office or telework location has een inspected and su!+ect to the correction of
the items noted elow meets the re(uirements of the <Insert Department Name> <Insert
policy name e.. !or"in from Home #olicy $NS! Sector !or"in %rom Home &inimum
Standards>
Signed
Name ($lease
print*
$osition
%rganisation
Date
'tem Correction re)uired Date corrected
=eassessment completed and approved
Signed
Name ($lease
print*
$osition
%rganisation
Date
($lease delete paragraph if not re)uired*
The home office or telework location has een inspected and does not meet the
re)uirements of <Insert Department Name> <Insert policy name e.. !or"in from Home
#olicy $NS! Sector !or"in %rom Home &inimum Standards>
Authority to work from home cannot e granted.
Signed
Name ($lease
print*
$osition
%rganisation
Date
Occupational Health and Safety Checklist %