Working From Home Checklist

1
Please watch the video before commencing.
2
Before commencing, please read and accept the Terms and Conditions
3
Your Details
4
Your name
First Name
Last Name
5
Email
example@example.com
6
Employer(this question can be removed)
7
Job role
8
DepartmentDrop down menu option is available for specific department requirements
9
Workspace & Schedule
10
Type of remote workspace
Private residence
Co-working space
Private non-residential office space
Public space ie. cafe, library
Other
11
Address of remote workspace
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Australia
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
12
Days per week working at this location
Please Select
Please Select
Variable
1
2
3
4
5
6
7
13
Work Habits
14
What percentage of your time do you spend:Slide bar to the appropriate percentage for that position in your workspace.
15
How often do you take a movement break away from your workstation?
Every 30 minutes
Every hour
Every 2-3 hours
Every 3-4 hours
Every 4-5 hours
I don't take regular breaks
16
How often do you take a visual break from looking at the screen?
Every 30 minutes
Every hour
Every 2-3 hours
Every 3-4 hours
Every 4-5 hours
I don't take regular breaks
17
Safety Hazards

In the following video, you'll learn about common safety hazards you might be exposed to when working from home, and some simple steps you can take to reduce the risks.

Please watch the video on the next page
18
Understanding The Risks Of Working From Home
19
Working From Home Checklist

The following checklist will help you identify potential safety hazards related to your home workspace and overall working from home arrangement.

Please continue to complete the WFH Checklist
20
Environment
Yes
No
Is the lighting suitable for you and your work tasks?
Row 0, Column 0
Row 0, Column 1
Are your monitors free from glare or reflections?
Row 1, Column 0
Row 1, Column 1
Are you comfortable with the temperature in your workspace, in all seasons?
Row 2, Column 0
Row 2, Column 1
Is there adequate ventilation?
Row 3, Column 0
Row 3, Column 1
Is there enough space to carry out all work tasks?
Row 4, Column 0
Row 4, Column 1
Is your work environment free from excessive noise and distractions?
Row 5, Column 0
Row 5, Column 1
Is the floor free of potential trip hazards? (ie power cables, extension cords)
Row 6, Column 0
Row 6, Column 1
Do you feel safe when entering and leaving your workspace?
Row 7, Column 0
Row 7, Column 1
Is the lighting suitable for you and your work tasks?
Are your monitors free from glare or reflections?
Are you comfortable with the temperature in your workspace, in all seasons?
Is there adequate ventilation?
Is there enough space to carry out all work tasks?
Is your work environment free from excessive noise and distractions?
Is the floor free of potential trip hazards? (ie power cables, extension cords)
Do you feel safe when entering and leaving your workspace?
Yes
Row 0, Column 0
No
Row 0, Column 1
Yes
Row 1, Column 0
No
Row 1, Column 1
Yes
Row 2, Column 0
No
Row 2, Column 1
Yes
Row 3, Column 0
No
Row 3, Column 1
Yes
Row 4, Column 0
No
Row 4, Column 1
Yes
Row 5, Column 0
No
Row 5, Column 1
Yes
Row 6, Column 0
No
Row 6, Column 1
Yes
Row 7, Column 0
No
Row 7, Column 1
1 of 8
21
Electrical Safety
Yes
No
Are all electrical plugs, sockets, switches and cables, free of visible signs of damage?
Row 0, Column 0
Row 0, Column 1
Has electrical equipment used for work, been tested and tagged?
Row 1, Column 0
Row 1, Column 1
Are power boards being used correctly and not overloaded?
Row 2, Column 0
Row 2, Column 1
Are all power boards in use, surge protected?
Row 3, Column 0
Row 3, Column 1
Are all electrical plugs, sockets, switches and cables, free of visible signs of damage?
Has electrical equipment used for work, been tested and tagged?
Are power boards being used correctly and not overloaded?
Are all power boards in use, surge protected?
Yes
Row 0, Column 0
No
Row 0, Column 1
Yes
Row 1, Column 0
No
Row 1, Column 1
Yes
Row 2, Column 0
No
Row 2, Column 1
Yes
Row 3, Column 0
No
Row 3, Column 1
1 of 4
22
Emergency & First Aid
Yes
No
Do you know how to contact emergency services in your area?
Row 0, Column 0
Row 0, Column 1
Do you have access to a first aid kit?
Row 1, Column 0
Row 1, Column 1
Is your workspace equipped with working smoke detectors?
Row 2, Column 0
Row 2, Column 1
Have you tested your smoke detectors in the last three months?
Row 3, Column 0
Row 3, Column 1
Do you have access to a fire blanket or fire extinguisher?
Row 4, Column 0
Row 4, Column 1
In case of emergency, are entrances and exits kept clear?
Row 5, Column 0
Row 5, Column 1
Do you know how to contact emergency services in your area?
Do you have access to a first aid kit?
Is your workspace equipped with working smoke detectors?
Have you tested your smoke detectors in the last three months?
Do you have access to a fire blanket or fire extinguisher?
In case of emergency, are entrances and exits kept clear?
Yes
Row 0, Column 0
No
Row 0, Column 1
Yes
Row 1, Column 0
No
Row 1, Column 1
Yes
Row 2, Column 0
No
Row 2, Column 1
Yes
Row 3, Column 0
No
Row 3, Column 1
Yes
Row 4, Column 0
No
Row 4, Column 1
Yes
Row 5, Column 0
No
Row 5, Column 1
1 of 6
23
Communication & Support
Yes
No
Do you have access to regular contact with supervisors and colleagues?
Row 0, Column 0
Row 0, Column 1
Are you kept informed about work events, training and activities while working remotely?
Row 1, Column 0
Row 1, Column 1
Do you know how to notify your employer, if you need assistance with a physical or mental health issue?
Row 2, Column 0
Row 2, Column 1
Do you know how to notify your employer about potential safety hazards in your workspace?
Row 3, Column 0
Row 3, Column 1
Do you have access to regular contact with supervisors and colleagues?
Are you kept informed about work events, training and activities while working remotely?
Do you know how to notify your employer, if you need assistance with a physical or mental health issue?
Do you know how to notify your employer about potential safety hazards in your workspace?
Yes
Row 0, Column 0
No
Row 0, Column 1
Yes
Row 1, Column 0
No
Row 1, Column 1
Yes
Row 2, Column 0
No
Row 2, Column 1
Yes
Row 3, Column 0
No
Row 3, Column 1
1 of 4
24
Remote Working Arrangement
Yes
No
Have you read and signed your employer’s remote working policy?
Row 0, Column 0
Row 0, Column 1
Have you and your employer agreed on a schedule of hours, workflow and workload expectations while working remotely?
Row 1, Column 0
Row 1, Column 1
Are you able to meet your job demands during the agreed work hours?
Row 2, Column 0
Row 2, Column 1
Are processes in place to periodically review the current remote working arrangement?
Row 3, Column 0
Row 3, Column 1
Have you read and signed your employer’s remote working policy?
Have you and your employer agreed on a schedule of hours, workflow and workload expectations while working remotely?
Are you able to meet your job demands during the agreed work hours?
Are processes in place to periodically review the current remote working arrangement?
Yes
Row 0, Column 0
No
Row 0, Column 1
Yes
Row 1, Column 0
No
Row 1, Column 1
Yes
Row 2, Column 0
No
Row 2, Column 1
Yes
Row 3, Column 0
No
Row 3, Column 1
1 of 4
25
Did you identify any potential safety hazards that you were unable to resolve, and need assistance with?
YESNO
26
Please provide further information
27
Please attach any relevant photos hereYou may attach up to 8 photos
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
28
Thanks!

Now we're going to help you set up your computer workstation.

Before we get started, please tell us about the equipment you use when you work from home.
29
Workstation Equipment
30
What type of seating do you use?
Adjustable ergonomic chair
Non-adjustable chair
Saddle seat
Sit-stand stool
I don't use a seat
Other
31
What type of work surface do you use?
Fixed-height desk
Height adjustable desk
Kitchen or dining table
Coffee table
I don't use a desk or work surface
Other
32
What electronic devices do you use?Choose as many as relevant
Laptop
Tablet
Smart phone
Desktop computer
Other
33
What monitors or displays are you using?Choose as many as relevant
Laptop or tablet screen
Smart-phone display
Single external monitor
Dual external monitor
More than two external monitors
Other
34
What type of mouse or input device do you use?
Standard mouse
Vertical mouse
Trackpad
Trackball / roller bar
e-pen
Other
35
What type of keyboard do you use?
Laptop or tablet keyboard
Compact external keyboard
Full-size external keyboard
Ergonomic keyboard
Other
36
Do you use any of these workstation accessories?Choose as many as relevant
Monitor stand
Monitor arm(s)
Laptop / tablet stand
Height-adjustable desktop converter
Document holder
Footrest
Headset or headphones
Anti-fatigue standing mat
Other
37
Is any of your equipment on loan from your employer?ie laptop, external monitor, chair
YESNO
38
Please enter the details of any loaned equipment belowEnter up to 4 items per page
Please Select
Please Select
Seating
Laptop
Desktop computer
Smart phone
Tablet
Docking station
External monitor (single)
External monitor (dual)
Monitor arm / stand
Keyboard
Mouse
Work surface (ie desk)
Webcam
Headset
Power board
Power cable
Other
Item
Asset number / description
Please Select
Please Select
Seating
Laptop
Desktop computer
Smart phone
Tablet
Docking station
External monitor (single)
External monitor (dual)
Monitor arm / stand
Keyboard
Mouse
Work surface (ie desk)
Webcam
Headset
Power board
Power cable
Other
Item
Asset number / description
Please Select
Please Select
Seating
Laptop
Desktop computer
Smart phone
Tablet
Docking station
External monitor (single)
External monitor (dual)
Monitor arm / stand
Keyboard
Mouse
Work surface (ie desk)
Webcam
Headset
Power board
Power cable
Other
item
Asset number / description
Please Select
Please Select
Seating
Laptop
Desktop computer
Smart phone
Tablet
Docking station
External monitor (single)
External monitor (dual)
Monitor arm / stand
Keyboard
Mouse
Work surface (ie desk)
Webcam
Headset
Power board
Power cable
Other
Item
Asset number / description
39
Do you need to add more loaned equipment?
YESNO
40
Please enter the details of any loaned equipment belowEnter up to 4 items
Please Select
Please Select
Seating
Laptop
Desktop computer
Smart phone
Tablet
Docking station
External monitor (single)
External monitor (dual)
Monitor arm / stand
Keyboard
Mouse
Work surface (ie desk)
Webcam
Headset
Power board
Power cable
Other
Item
Asset number / description
Please Select
Please Select
Seating
Laptop
Desktop computer
Smart phone
Tablet
Docking station
External monitor (single)
External monitor (dual)
Monitor arm / stand
Keyboard
Mouse
Work surface (ie desk)
Webcam
Headset
Power board
Power cable
Other
Item
Asset number / description
Please Select
Please Select
Seating
Laptop
Desktop computer
Smart phone
Tablet
Docking station
External monitor (single)
External monitor (dual)
Monitor arm / stand
Keyboard
Mouse
Work surface (ie desk)
Webcam
Headset
Power board
Power cable
Other
item
Asset number / description
Please Select
Please Select
Seating
Laptop
Desktop computer
Smart phone
Tablet
Docking station
External monitor (single)
External monitor (dual)
Monitor arm / stand
Keyboard
Mouse
Work surface (ie desk)
Webcam
Headset
Power board
Power cable
Other
Item
Asset number / description
41
Seating

In the next video, you'll learn how to choose the right kind of seating for your workspace and how to adjust it to suit your body.

Please watch the video on the next page
42
How To Choose & Adjust Your Seating
43
Check your seating

Take a moment to evaluate your current seating and make any adjustments you feel necessary to be comfortable.

If you're happy with your seating as it is, that's fine!
44
Please take a photo of your seating.Please use LANDSCAPE orientation. Photos must be in JPEG format.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
45
Workstation setup

In the next video, you'll learn how to set up your workstation to encourage healthy posture and reduce the risk of injury.

Please watch the video on the next page
46
How To Setup A Computer Workstation
47
Check your setup

Take a moment to evaluate your workstation setup and make any adjustments you feel necessary.

Remember, everyone's needs are different. If you're happy with how things are already, that's fine!
48
Please take a photo of your workstationPlease use LANDSCAPE orientation. Photos must be in JPEG format.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
49
Did you identify any issues with your seating or workstation?
YESNO
50
Please describe any issues you have with your seating or workstation.
51
Taking Care Of Your Wellbeing

Working from home can be a great experience, but it can have a negative impact on your physical and mental health.

It's important to be aware of the risks and the things you can do to minimise them.

Please watch the video on the next page
52
Staying Healthy at Home
53
Thanks!

You're nearly done. Just a few final questions.
54
Wellbeing Check-InWith regards to Work Form Home, on a scale of 1-10:
How connected to you feel to your work colleges?
How clear are you upon the expectations of your role?
How effective are you at setting boundaries between work and home life?
Friendliness
1
2
3
4
5
6
7
8
9
10
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4Row 0, Column 5Row 0, Column 6Row 0, Column 7Row 0, Column 8Row 0, Column 9
1
2
3
4
5
6
7
8
9
10
Row 1, Column 0Row 1, Column 1Row 1, Column 2Row 1, Column 3Row 1, Column 4Row 1, Column 5Row 1, Column 6Row 1, Column 7Row 1, Column 8Row 1, Column 9
1
2
3
4
5
6
7
8
9
10
Row 2, Column 0Row 2, Column 1Row 2, Column 2Row 2, Column 3Row 2, Column 4Row 2, Column 5Row 2, Column 6Row 2, Column 7Row 2, Column 8Row 2, Column 9
1
2
3
4
5
6
7
8
9
10
Row 3, Column 0Row 3, Column 1Row 3, Column 2Row 3, Column 3Row 3, Column 4Row 3, Column 5Row 3, Column 6Row 3, Column 7Row 3, Column 8Row 3, Column 9
How connected to you feel to your work colleges?
How clear are you upon the expectations of your role?
How effective are you at setting boundaries between work and home life?
Friendliness
1
2
3
4
5
6
7
8
9
10
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4Row 0, Column 5Row 0, Column 6Row 0, Column 7Row 0, Column 8Row 0, Column 9
1
2
3
4
5
6
7
8
9
10
Row 1, Column 0Row 1, Column 1Row 1, Column 2Row 1, Column 3Row 1, Column 4Row 1, Column 5Row 1, Column 6Row 1, Column 7Row 1, Column 8Row 1, Column 9
1
2
3
4
5
6
7
8
9
10
Row 2, Column 0Row 2, Column 1Row 2, Column 2Row 2, Column 3Row 2, Column 4Row 2, Column 5Row 2, Column 6Row 2, Column 7Row 2, Column 8Row 2, Column 9
1
2
3
4
5
6
7
8
9
10
Row 3, Column 0Row 3, Column 1Row 3, Column 2Row 3, Column 3Row 3, Column 4Row 3, Column 5Row 3, Column 6Row 3, Column 7Row 3, Column 8Row 3, Column 9
55
Would you like to inform your employer about any physical or mental health issues you're experiencing, related to working from home?Disclaimer:This question is not a substitute for medical, psychological, or crisis support. If you are experiencing serious physical or mental health concerns, please seek professional assistance from a qualified healthcare provider or contact relevant emergency or support services immediately.
YESNO
56
Please provide further information
57
Do you understand the potential health risks associated with remote working and computer-based work, and what you can do to reduce the risk?
YESNO
58
Support is available

If you need help, you can access free and confidential counselling via your employer's Employee Assistance Program (EAP)

Call the phone number below for more information:

(Your company EAP details will be displayed here)
59
If there's an immediate risk of harm to yourself or others, please call 000

If you or someone you know needs help, free and confidential counselling services are availalble:

Lifeline 13 11 14

Beyond Blue 1300 22 46 36

Suicide Call Back Service 1300 659 467
60
You've finished the trial!

Please SIGN and SUBMIT on the next page and check your inbox for the report. We value your feedback, so please take a moment to complete a quick one minute survey at the end.

Have a great day!
61
By signing this form, you acknowlege that the information you've provided is true and accurately reflects your current working from home arrangement.Please sign below and tap SUBMIT
Clear
Should be Empty:

Workstation Equipment