Display Screen Equipment (DSE) Risk Assessment Checklist
Complete this DSE risk assessment to record workstation setup, identify display screen equipment risks, and note any follow-up actions needed.
DSE Assessment Details
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor Name
*
Employee / Department Name or Work Area
*
Workstation / Desk Location
*
Workstation Checklist
Workstation checklist
*
Rows
Pass
Fail
Screen position and height
1
2
Glare or reflections on screen
3
4
Keyboard and mouse placement
5
6
Chair support and adjustability
7
8
Desk height and leg clearance
9
10
Lighting conditions
11
12
Cable management
13
14
Additional workstation observations
Any immediate workstation issue identified?
*
No
Yes
Describe any immediate issue identified
User Comfort and Action Follow-up
Discomfort symptoms or issues noticed
Break frequency / screen-use pattern
Take a break every 20 minutes
Take a break every hour
Extended screen use with few breaks
Varies by workload
Other
Corrective actions required or recommendations
Submit
Should be Empty: