Working From Home OH&S Checklist

Contractor name: Nino Francisco Calzada Alamo

Client company: Kennards Hire

Reports to: Dong Qiu

This checklist is designed to demonstrate you have an adequate set-up at home, and to help Peoplegig assess work
health and safety risks prior to you commencing work from home arrangements.

Please read through the below checklist ensuring you circle Y = Yes or N = No. If answered no, please provide
reasons in the comments box.

The contractor is ultimately responsible for monitoring the workplace and taking reasonable steps to minimise and
eliminate risk, so far as is reasonably practicable.

1. Work Environment Comments

Is there a designated home office or

Y/N Y
workstation area with a desk?

Do you have a fully adjustable (height and back

Y/N Y
rest) chair with adequate lumbar support?

Is this area clear of slip or trip hazards and kept

Y/N Y
clean?

Is there sufficient lighting for the task being

performed, easy to see and comfortable on the Y/N Y
eyes?

Can glare and reflections be controlled? Y/N Y

Ventilation and room temperature can be

Y/N Y
controlled, regardless of the season?

Area is suitably quiet with no excessive noise? Y/N Y

Location, height and other physical

characteristics of furniture and computer/s are
suited to the task and taken into consideration Y/N Y
other factors (for example, exit routes,
direction of light source)?

Flooring is even with no damage or trip hazards Y/N Y

(e.g.: uneven tiles, pulled up carpet)?

Suitable storage for documents and books is

Y/N Y
available?

All power outlets are set up correctly and not

overloaded with double adapters and power Y/N Y
boards?

Is there a suitable first aid kit in the house? Y/N Y

Have you ALL the equipment required to

perform your assignments from home?
Y/N Y
If No, please outline the equipment missing in
comments

It is a mandatory requirement for you to

provide a photo of your workspace at home.
Y/N Y
Have you submitted a photo as part of this
process?

2. Communication Comments

Have you agreed on a reasonable

communication strategy between you and your
manager (e.g.: call in, email)?
Y/N Y
Please outline the agreed comms plan in
comments?

Will you inform your manager if there is any

change that may impact your health and safety
Y/N
or the health and safety of another worker
(e.g.: renovations/moving house)?

3. Physical Activity Comments

Will you take appropriate breaks to ensure

repetitive actions are not continued for long Y/N Y
periods?

Will you ensure that you have a comfortable Y/N Y

posture throughout the day?

Will you ensure any lifting, pushing, or carrying

Y/N Y
type tasks is well within your physical capacity?

4. Mental Health Comments

Have you established boundaries around your

work hours with your partner, children and/or Y/N Y
house mates?

Are regular meetings and catch-ups scheduled

with your manager, team and/or clients to help
Y/N Y
you maintain ongoing contact and foster
positive working relationships?

Will you stay connected and updated on work

Y/N Y
matters via phone, email and/or online?

Will you use outdoor spaces where possible

when you take breaks and try to incorporate
Y/N Y
some exercise or other activity as part of your
working day?

Will you identify any potential distractions and

put strategies in place to minimise them, for
Y/N Y
example separating your workstation from the
rest of the house?

5. Notification Requirements Comments

Are there any WHS issues or hazards that you

are aware of that may affect your ability to
work safely from home? Y/N N

If Yes, please outline in comments

6. Authorisations

The information in this checklist and

Y/N
photograph/s provided is true and correct.
YES
Contractor name:
Contractor signature: ALAMO, NINO FRANCISCO CALZADA

___________________________________________

Date:

___________________________________________

11/13/2023

___________________________________________