Form 151 "Work Health and Safety Checklist - Working From Home or From a Privately-Funded or Satellite Office" - Australia

Form 151 is a Australian Department of Finance form also known as the "Work Health And Safety Checklist - Working From Home Or From A Privately-funded Or Satellite Office". The latest edition of the form was released in April 1, 2018 and is available for digital filing.

Download a PDF version of the Form 151 down below or find it on Australian Department of Finance Forms website.

ADVERTISEMENT
ADVERTISEMENT

Download Form 151 "Work Health and Safety Checklist - Working From Home or From a Privately-Funded or Satellite Office" - Australia

Download PDF

Fill PDF online

Rate (4.3 / 5) 52 votes
Page background image
Form 151
Apr 2018
Page 1 of 3
Members of Parliament (Staff) Act 1984 Employees
WORK HEALTH AND SAFETY CHECKLIST
WORKING FROM HOME OR FROM A PRIVATELY-FUNDED OR SATELLITE OFFICE
Do NOT return your completed form to Ministerial and
Enquiries: Ministerial and Parliamentary Services
Parliamentary Services
Email:
mpshelp@finance.gov.au
Phone:
(02) 6215 3333
A copy of the completed checklist should be retained on the
employee’s personnel file as evidence of the condition of the
work area at the time the arrangements to work from home
or a privately-funded office were approved.
The Work Health and Safety (WHS) Checklist is designed to help MOP(S) Act employees and managers to assess WHS risks in the home,
privately-funded or satellite office. This checklist should be read together with the ‘Working from Home’ guideline. This checklist was prepared
referencing the NSW WorkCover Authority publication Health and Safety in the Office Guide 2004, and Comcare’s publication Officewise.
It is recommended that, where practicable, a home inspection be required by the employing Senator or Member prior to approving the
employee’s working from home arrangements. Where an independent inspection is not practicable, the inspection should be carried out by the
employee and discussed with the employing Senator or Member.
WORK ENVIRONMENT
Designated work area
Yes
No
• The floor of the work area is level and there is limited use of mats/or rugs
Environmental conditions
Yes
No
• Lighting is adequate for the tasks being performed. Easy to see and comfortable on
the eyes
• Glare and reflection can be controlled
• Ventilation and room temperature can be controlled, regardless of season
• There is no excessive noise affecting the work area
• Walkways are clear of clutter and trip hazards, such as trailing electrical cords
• The work area is segregated from other hazards in the home, for example, hot
cooking surfaces in the kitchen
• Non smoking environment
Emergency exit
Yes
No
• Path to the exit is reasonably direct
• Path to the exit is sufficiently wide and free of obstructions or trip hazards to allow
unimpeded passage
Safety equipment checklist
Yes
No
• The work area contains a first aid kit
• The work area contains a fire extinguisher able to be used to extinguish minor fires
• A smoke detector is installed in/near the work area and is properly maintained
Security
Yes
No
• Security is sufficient to prevent unauthorised entry
• A communications procedure has been established to ensure regular contact between
employee and manager
• The work area can be secured
• If working from a Privately Funded Office (PFO), or Satellite Office (SO) the relevant
Australian Federal Police Liaison team has been notified of the establishment of the
PFO or SO and its address
Form 151
Apr 2018
Page 1 of 3
Members of Parliament (Staff) Act 1984 Employees
WORK HEALTH AND SAFETY CHECKLIST
WORKING FROM HOME OR FROM A PRIVATELY-FUNDED OR SATELLITE OFFICE
Do NOT return your completed form to Ministerial and
Enquiries: Ministerial and Parliamentary Services
Parliamentary Services
Email:
mpshelp@finance.gov.au
Phone:
(02) 6215 3333
A copy of the completed checklist should be retained on the
employee’s personnel file as evidence of the condition of the
work area at the time the arrangements to work from home
or a privately-funded office were approved.
The Work Health and Safety (WHS) Checklist is designed to help MOP(S) Act employees and managers to assess WHS risks in the home,
privately-funded or satellite office. This checklist should be read together with the ‘Working from Home’ guideline. This checklist was prepared
referencing the NSW WorkCover Authority publication Health and Safety in the Office Guide 2004, and Comcare’s publication Officewise.
It is recommended that, where practicable, a home inspection be required by the employing Senator or Member prior to approving the
employee’s working from home arrangements. Where an independent inspection is not practicable, the inspection should be carried out by the
employee and discussed with the employing Senator or Member.
WORK ENVIRONMENT
Designated work area
Yes
No
• The floor of the work area is level and there is limited use of mats/or rugs
Environmental conditions
Yes
No
• Lighting is adequate for the tasks being performed. Easy to see and comfortable on
the eyes
• Glare and reflection can be controlled
• Ventilation and room temperature can be controlled, regardless of season
• There is no excessive noise affecting the work area
• Walkways are clear of clutter and trip hazards, such as trailing electrical cords
• The work area is segregated from other hazards in the home, for example, hot
cooking surfaces in the kitchen
• Non smoking environment
Emergency exit
Yes
No
• Path to the exit is reasonably direct
• Path to the exit is sufficiently wide and free of obstructions or trip hazards to allow
unimpeded passage
Safety equipment checklist
Yes
No
• The work area contains a first aid kit
• The work area contains a fire extinguisher able to be used to extinguish minor fires
• A smoke detector is installed in/near the work area and is properly maintained
Security
Yes
No
• Security is sufficient to prevent unauthorised entry
• A communications procedure has been established to ensure regular contact between
employee and manager
• The work area can be secured
• If working from a Privately Funded Office (PFO), or Satellite Office (SO) the relevant
Australian Federal Police Liaison team has been notified of the establishment of the
PFO or SO and its address
Form 151
Apr 2018
Page 2 of 3
Electrical
Yes
No
• Power outlets are not overloaded with double adapters and power boards
• Earth leakage circuit protection is in place for work related equipment
• Electrical cords are safely stowed
• Connectors, plugs and outlet sockets are in safe working order
• Electrical equipment is free from any obvious external damage
WORKSTATION SET UP
Work surface
Yes
No
• There is adequate leg space under the workstation
• A footrest is available if needed
• From the seated position, the most frequently used items are within easy reach
• Cables are stowed away
• There are no sharp contact points on the workstation or other equipment
Chair
Yes
No
• The seat height, seat tilt, angle and back rest are all adjustable
• The chair has a stable base (preferably five-star)
• The chair moves freely
• There is adequate lumbar support
• The chair’s padding is adequate
• The seat height is adjusted so that arms and forearms are at right angles or slightly
greater and forearms and hands form straight lines when resting on the keyboard
• The seat back is adjusted to support the lumbar curve of the lower back
• Feet are flat on the floor or on a footrest so that knees are bent at right angles and
thighs are horizontal to floor
• The arm rests can be stowed whilst typing, but may be utilised to provide support
during other activities
Keyboard and mouse
Yes
No
• Keyboard to user distance allows user to relax shoulders with elbows close to the
body
• Keyboard position is flat
• Mouse is placed directly next to the keyboard
• Mouse is at same level as the keyboard
Monitor
Yes
No
• Monitor height is adjusted so top of screen is at or slightly lower than eye level (may
need to be lower where bifocals are used)
• Viewing distance is between 350mm – 750mm
• Monitor and keyboard are placed directly and symmetrically in front of user
• Monitor is positioned to avoid glare, i.e. perpendicular to window or other strong light
source
Form 151
Apr 2018
Page 3 of 3
NATURE OF TASKS
Physical demands of tasks
Yes
No
• Safe posture is adopted
• Any lifting, pushing or carrying type task is well within physical capacity
Work practices
Yes
No
• Wrists are kept straight and not supported on any surface while typing
• Sitting posture is upright or slightly reclined, with lower back supported
• From the seated position the telephone is within easy reach, and either a hand is used
to hold the telephone receiver or a headset is worn (ie no cradling of the receiver
between shoulder and ear)
• Long periods of continuous activity are broken by performing other tasks, changing
position, standing up and stretching
• Repetitive actions are not continued for long periods without appropriate breaks.
Breaks should be taken after every 30 mins of keyboarding, including standing at least
once per hour
OTHER FACTORS
Other
Yes
No
• Telephone or other communication devices are readily available to allow effective
communication in an emergency situation
• Emergency contact numbers and details are known
• A process is in place for the prompt reporting of incidents
Individual factors
Yes
No
• Arrangements are in place for person(s) other than the employee to care for persons
dependent on the employee during the employee’s ordinary hours of duty
• The employee’s fitness and health is suitable to the tasks to be undertaken
• Any special needs to ensure health and safety have been advised to the Senator or
Member or authorised person
SIGNATURES
The designated home office, privately-funded or satellite office area has been inspected and any risks to
safety discussed with the employing Senator or Member.
The employee is aware that should there be a change to the location or conditions of the work-space:
• the employing Senator or Member must be informed; and
• a new checklist must be completed and placed on the employee’s personnel file.
Signature of employee
Date
Please print and sign this form
/
/
Name (please print)
Signature of
Date
Senator/Member/
Please print and sign this form
Authorised person
/
/
Name (please print)
Position
Privacy Collection Notice — Consistent with the Privacy Act 1988, the Department of Finance (Finance) uses the personal information provided in this form
to facilitate the administration of work expenses and allowances for Parliamentarians and their employees under the parliamentary work expenses framework.
Details of the related expenditure may be tabled in Parliament, published on Finance’s website, or provided to the Special Minister of State, the Independent
Parliamentary Expenses Authority, relevant service providers, or publicly, as authorised by law. Further details on the collection, storage and use of personal
information provided is available at
www.maps.finance.gov.au/privacy.html
Page of 3