Workstation Assessment Request Form (Part 1/3)

    Organisation Details

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Workstation Assessment Request Form (Part 2/3)

    Employee 1 details

  • Type of assessment. Please choose from the options below:

  • An assessment of your current workstation set up to identify any potential risk of injury. Adjustments may be required to the position of your keyboard, monitor, desk and chair to ensure optimum comfort.
  • This assessment will focus on the physical demands of your job and length of time it takes to complete these tasks. To minimise the risk of injury, the consultant will make recommendations for suitable equipment (if needed). Advice on safe work practices is included in this assessment.
  • A comprehensive assessment carried out by a qualified allied health professionals with the knowledge and experience in ergonomics and physical anatomy. Consideration is given to your tasks and duties, current symptoms and relevant past medical history. Recommendations regarding suitable equipment and advice on safe work practices are part of this assessment.
  • If you regularly undertake office work from home, this assessment will consist of two things; a safety inspection of your designated work area and either an Injury Prevention or a Comprehensive depending on your needs.
  • Supervisor details

  • Employee 2 details

  • Type of assessment. Please choose from the options below:

  • An assessment of your current workstation set up to identify any potential risk of injury. Adjustments may be required to the position of your keyboard, monitor, desk and chair to ensure optimum comfort.
  • This assessment will focus on the physical demands of your job and length of time it takes to complete these tasks. To minimise the risk of injury, the consultant will make recommendations for suitable equipment (if needed). Advice on safe work practices is included in this assessment.
  • A comprehensive assessment carried out by a qualified allied health professionals with the knowledge and experience in ergonomics and physical anatomy. Consideration is given to your tasks and duties, current symptoms and relevant past medical history. Recommendations regarding suitable equipment and advice on safe work practices are part of this assessment.
  • If you regularly undertake office work from home, this assessment will consist of two things; a safety inspection of your designated work area and either an Injury Prevention or a Comprehensive depending on your needs.
  • Supervisor's details

  • Employee 3 details

  • Type of assessment. Please choose from the options below:

  • An assessment of your current workstation set up to identify any potential risk of injury. Adjustments may be required to the position of your keyboard, monitor, desk and chair to ensure optimum comfort.
  • This assessment will focus on the physical demands of your job and length of time it takes to complete these tasks. To minimise the risk of injury, the consultant will make recommendations for suitable equipment (if needed). Advice on safe work practices is included in this assessment.
  • A comprehensive assessment carried out by a qualified allied health professionals with the knowledge and experience in ergonomics and physical anatomy. Consideration is given to your tasks and duties, current symptoms and relevant past medical history. Recommendations regarding suitable equipment and advice on safe work practices are part of this assessment.
  • If you regularly undertake office work from home, this assessment will consist of two things; a safety inspection of your designated work area and either an Injury Prevention or a Comprehensive depending on your needs.
  • Supervisor's details

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Invoicing Details (Part 3/3)

    Invoicing Details

  • Conditions

  • Your personal information is collected for the purposes of course administration, statistical analysis and program evaluation. Your information will not be used for any other purpose except as required or authorised by or under law.
  • Should you need to cancel the workstation assessment, please notify us at least 24 hours prior to your scheduled appointment. Cancellations made after that time, will incur a fee equivalent to our minimum call-out fee of 2 hours which will be charged to your department/organisation.
 

Verification

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