Remote Work Safety Check
Please complete this safety check form to ensure a safe remote work environment.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Do you have a dedicated workspace free from hazards?
*
Yes
No
Is your workstation ergonomically set up?
*
Yes
No
Do you have reliable internet connectivity?
*
Yes
No
Are emergency contact numbers easily accessible?
*
Yes
No
Do you have adequate lighting in your workspace?
*
Yes
No
Any additional safety concerns or comments?
Submit
Should be Empty: