Setting Up an Alternative

Workplace Environment
Checklist
Health and Safety Directorate

This checklist is designed to guide employees in the setup of a safe alternative

workplace environment. Employees should complete the checklist and discuss any
requirements relative to their health and safety with their manager as part of the process
of establishing flexible work arrangements.

Staff requiring tailored support or work station adjustments for a specific health condition should refer to the department’s Return to
Work Program and seek advice from the Health and Safety Directorate. Please also refer to the Setting up an Alternative
Workplace Environment Fact Sheet for further information.

If you respond NO to any of the below points, please discuss alternative arrangements with your manager.
YES/NO
Work Environment (circle Comments
one)
1. The work area is situated away from other household members or activities, if the
YES NO
proposed arrangement is to work from home

2. There is no excessive noise affecting the work area YES NO

3. It is a non-smoking environment YES NO

4. Security is sufficient to prevent unauthorised entry and the work area can be
YES NO
secured
5. The work area is free from trip hazards (e.g. mats, power cords, adjoining steps,
YES NO
etc)
6. The work area and field of vision is free of direct glare or reflections (e.g. from
YES NO
lights, windows, etc)
7. The room has sufficient power points available for the equipment used. No
double adaptors, no multiple power boards at the same socket, no multiple YES NO
extension leads at the same socket
8. Equipment, power cords and extension cords are in good working condition with
no obvious damage (fraying, splicing or broken installation). Wires or cords do YES NO
not run under carpets or rugs, through doorways or in passage ways

9. The work area has a first aid kit that is accessible and appropriate for use YES NO

10. A communication arrangement is established. Communication devices are

available and effective in the event of an emergency and emergency contact YES NO
details are known

11. A process for the prompt notification of an incident or injury is in place YES NO

NSW Department of Education | Factsheet – V1 | Health and Safety Directorate: 1800 811 523 www.dec.nsw.gov.au 1
 YES/NO
Work Station (circle
one)
To be1.completed
The workstation includes a fit for purpose work surface, hard drive and monitor,
by employee:
key board and mouse. A headset/hands free device, document holder and foot rest YES NO
Name________________________________________________
may also be included as required for the work being conducted.
Signature_____________________________
2. The chair is adjusted so that your feetDate checklist
are flat on thecompleted___________
floor and your knees bent at
right angles with thighs parallel
To be completed by manager (delegate): to the floor. Please purchase a footrest if one is YES NO
required.
Name________________________________________________
3. The chair backrest is adjusted to support your lower back and allow you to sit up
Signature_____________________________ Date checklist reviewed___________ Adjustments YESmade
NOY / N
straight
4. The chair moves freely and is not restricted by mats, power cords, or other
YES NO
hazards
5. Chair arm rests are removed, stowed away or lowered while typing so a safe and
YES NO
comfortable posture is adopted and they are able to pass under the table
6. The centre of the monitor/screen and keyboard are positioned directly in front of
YES NO
you so you are not twisting in your chair.
7. The monitor/screen is at a distance from you where you can see clearly and easily
without straining. The top of the screen is at a slightly lower height than eye level.
YES NO
If using a laptop, ensure a laptop raiser is used to position the screen
appropriately.
8. The keyboard is positioned at a distance where your elbows are close to your
body and your shoulders are relaxed. If using a laptop on a monitor raiser or dock, YES NO
use an external USB or wireless keyboard.
9. The mouse is placed immediately next to the keyboard. Wrists are kept straight
and not supported on any surface while typing. Only use the laptop trackpad for YES NO
small amounts of time (1%-7% of the time or 4-30 minutes)

10. The most frequently used items are within easy reach from the seated position YES NO

11. There are no sharp contact points on the workstation or other equipment YES NO

12. A safe and comfortable posture is able to be adopted and periods of continuous
activity will be broken by performing other tasks, changing position, standing up YES NO
and stretching

No. Item Correction required Date corrected

NSW Department of Education | Factsheet – V1 | Health and Safety Directorate: 1800 811 523 www.dec.nsw.gov.au 2