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DSE assessment template
For DSE users and workstation assessors. Record user and work, workstation checks and assessor review. Try the form below, see every question or download a blank PDF or Word copy.
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Who needs a DSE workstation assessment?
HSE describes DSE users as workers who use display screen equipment daily for continuous periods of an hour or more. The regulations can apply to home and hybrid working. Software or a self-assessment alone is not the completed assessment: HSE says a trained assessor should review results and resolve doubtful points.
Last updated . Facts checked by the SiteSurvey team on 6 October 2026 against HSE workstation assessment and HSE display screen equipment at home.
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Want to see one filled in? See a completed DSE workstation assessment report (PDF), made by SiteSurvey from a fictional site visit.
Fill it in on a phone or tablet
Your team completes the dse workstation assessment on site in the SiteSurvey app on iPhone, iPad and Android phones and tablets. The project name and address fill in for them, it works without signal, and it syncs when the device is back online with photos kept against the question they answer.
Customers and subcontractors do not need the app: send them a link and they can fill it in from any browser.
Every question in the DSE workstation assessment template
A workstation assessment with equipment, posture and work-pattern checks, user concerns, assessor review, adjustments and follow-up evidence. 5 sections and 36 questions. Follow-up questions and guidance appear only when an answer calls for them, so the person on site never sees the ones that do not apply.
Make it your own: every question is editable
This is a starting point, not a fixed form. Once it is in your SiteSurvey account you can reword any question, add or remove questions, sections and answer options, and add your own logo, so it fits the way your team works and the jobs you do.
Details you only enter once
Add this form to a project in SiteSurvey and it fills in what the project already knows, so nobody on site retypes it and every form on the job uses the same names. Anything filled in can still be changed.
- Project: the project name
- Site or premises address: the site address, from the space or the project
- Client or organisation: the project's customer
Record details and scope
- ProjectShort answer
Filled in from the project in SiteSurvey.
Fills in from the project name - Site or premises addressShort answerFills in from the site address, from the space or the project
- Client or organisationShort answerFills in from the project's customer
- Record date*Date
- Person completing the record*Short answer
- CheckThis records workplace assessment and adjustments, not a medical diagnosis. Record practical needs without unnecessary medical details.
- CheckHSE describes DSE users as workers who use display screen equipment daily for continuous periods of an hour or more. The regulations can apply to home and hybrid working. Software or a self-assessment alone is not the completed assessment: HSE says a trained assessor should review results and resolve doubtful points.
User and work
- User name or staff reference*Short answer
- Work setting*Choose one
- Office
- Home
- Hybrid
- Other
- Tasks, duration and breaks or changes of activity*Notes
- User concerns and practical adjustment needsNotes
Record the user's experience and the task or period associated with it. Avoid diagnosing a condition from a workstation observation.
- Trained assessor reviewing the record*Short answer
Workstation checks
- Display position and readability suitable*Choose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- Action, limitation or reason not applicable*NotesShown only when the answers above make it relevant
- Keyboard, pointing device and work surface suitable*Choose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- Action, limitation or reason not applicable*NotesShown only when the answers above make it relevant
- Chair and seating adjustments suitable*Choose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- Action, limitation or reason not applicable*NotesShown only when the answers above make it relevant
- Space, lighting and glare addressed*Choose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- Action, limitation or reason not applicable*NotesShown only when the answers above make it relevant
- Working posture, breaks and task variation considered*Choose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- Action, limitation or reason not applicable*NotesShown only when the answers above make it relevant
- Workstation photos without unnecessary personal informationPhotos
Assessor review
- Assessor findings and points clarified*Notes
- Adjustments agreed with the userNotes
- Follow-up dateDate
- Follow-up findings: have the changes resolved the problems?Notes
Actions and review
- Are further actions required?*Choose one
- Yes
- No
- Further actionRepeat for each further action. Each one asks:Shown when “Are further actions required?” is “Yes”
- Action and evidence reference*Notes
- Person responsible*Short answer
- Target dateDate
- Action status*Choose one
- Open
- In progress
- Completed
- Completion evidence*NotesShown when “Action status” is “Completed”
- Outstanding limitations and information to pass onNotes
- Record status*Choose one
- Ready for review
- Further work needed
- Work or use stopped
- Reviewed byShort answer
- Review dateDate
- Author signature*Signature
- CheckSigning records the information entered. It does not itself certify legal compliance, remove a limitation or authorise unsafe work.
Scope and responsibility
This records workplace assessment and adjustments, not a medical diagnosis. Record practical needs without unnecessary medical details.
What a useful entry looks like
User concerns and practical adjustment needs
Record the user's experience and the task or period associated with it. Avoid diagnosing a condition from a workstation observation.
User reports difficulty reading the second screen during spreadsheet work and reaching the mouse when reference documents are on the desk.
Fictional example of record wording. Use the actual evidence and approved arrangements for your job; this is not a completed report or an instruction to carry out the work.
See it filled in
A completed DSE workstation assessment report, made by SiteSurvey from a fictional site visit: every answer, the photos, the guidance that applied and the sign-off, ready to send as a PDF.
DSE Workstation Assessment FAQs
How should I record “User concerns and practical adjustment needs”?
Record the user's experience and the task or period associated with it. Avoid diagnosing a condition from a workstation observation.
Can staff complete it themselves?
They can provide the workstation information and observations. A trained assessor should review the results, clarify concerns and arrange suitable action.
Can it cover home working?
Yes. Select home or hybrid and describe the actual setup and work pattern. Do not assume a photograph alone establishes a suitable workstation.
Does it collect medical history?
No medical-history section is provided. Record practical concerns and adjustment needs without adding unnecessary sensitive information.
What are the limits of this template?
This records workplace assessment and adjustments, not a medical diagnosis. Record practical needs without unnecessary medical details.
Can I complete this form on site and share the record?
In the SiteSurvey app the form works offline, with photos and signatures recorded against the questions. Share the completed record as a PDF or a link. Dates and action owners are recorded fields; this form does not send reminders or update other systems.
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