WORKING FROM HOME HEALTH AND SAFETY AND WELLBEING SELF ASSESSMENT

Name(required)

Date(required)

Address(required)

Details of the work to be carried out at home:(required)

Details of room / space used for working from home: (required)

Detail Company equipment supplied, if any:

Will your job involve any of the following whilst working from home? (please tick): –(required)

Computer use Manual Handling Use of electrical equiptment

Details:

Is the room/area separate from other living areas in the home?(required)

Yes No

Details:(required)

Is the room/area used accessible without climbing a ladder?(required)

Yes No

Details:

Is there enough space to safely accommodate all necessary furniture and equipment?(required)

Yes No

Details:

Are walkways clear of tripping hazards, such as trailing cables?(required)

Yes No

Details:

Is there a source of heating to maintain a comfortable temperature?(required)

Yes No

Details:

Does the room have an opening window for ventilation?(required)

Yes No

Details:

Is there adequate light to comfortably see documents and your computer screen?(required)

Yes No

Details:

Can you reach storage shelves without having to stretch over the desk?(required)

Yes No

Details:

Do you generally find your workstation comfortable to use?(required)

Yes No

Details:

Do you know how your workstation should be arranged to achieve the most comfortable posture? (required)

Yes No

Details:

Do you have somewhere secure to store confidential Company documents in order to maintain Data Protection Act?(required)

Yes No

Details:

Do you use a computer/laptop at home for work purposes?(required)

Yes No

Details:

Do you have to use a computer/laptop intensively on a regular basis when working from home?(required)

Yes No

Details:

Does your electrical equipment have any signs of damage?(required)

Yes No

Details:

If you have any items of Company equipment at home, are they marked to show they have received a portable appliance test?(required)

Yes No

When was this equipment last checked?(required)

Do you know how to safely use the equipment you use to work from home?(required)

Yes No

Details:

Do you have an escape plan in case of fire? (required)

Yes No

Details:

Do you have a smoke alarm fitted? (required)

Yes No

Details:

Do you know what to do in the event of having an accident at home? (required)

Yes No

Details:

Do you have regular supervision with your line Manager? (required)

Yes No

Details:

Do your working hours at home comply with the current Working Time Regulations? (required)

Yes No

Details:

Does your Line manager review your working from home arrangements with you at supervision? (required)

Yes No

Details:

Are you aware of the requirement of Arcus Attendance Procedure that requires you to report any sickness, whether working from home or at any other work base? (see sickness policy) (required)

Yes No

Details:

Do you have the opportunity to contact and meet with other team members as appropriate (‘Home worker’ work style volunteers only)? (required)

Yes No

Details:

Do you have any other comments about your working conditions or any other health and safety concerns? Please detail the action that is to be taken, if any, to address any issues highlighted in the assessment.(required)