Emergency homeworking questionnaire for staff
Produced in partnership with DG Legal

The following Practice Management precedent produced in partnership with DG Legal provides comprehensive and up to date legal information covering:

  • Emergency homeworking questionnaire for staff

Emergency homeworking questionnaire for staff

    1. 1

      About you

      Name[Insert name]
      Role[Insert role]
      Address[Insert address]
      Contact telephone number(s)
      Please provide both landline and mobile telephone numbers where available
      [Insert contact telephone numbers]
      Date form completed[Insert date]
    1. 2

      Assessment

      Please answer ‘yes’ or ‘no’ to all of the below questions. Do not be concerned if you cannot answer ‘yes’ in every case—it is essential that you answer the questions honestly. [Insert name of organisation] will use the answers to conduct a risk assessment. As part of this process, we will decide if we need to provide any further equipment or determine if any other measures need to be implemented. [Insert name of organisation] may need to contact you to discuss your answers further and to discuss how any measures may be implemented.

      Please return the completed form to [insert details of where the member of staff should send the completed form].

      1. 2.1

        Working environment

        Do you have a separate working area away from the rest of your living space, where you can work without disruption?☐ Yes
        ☐ No
        Do you have a suitable table or desk and chair which enables you to sit comfortably?☐ Yes
        ☐ No
        Can you adjust your equipment to a comfortable viewing position? ☐ Yes
        ☐ No
        Is your working area ventilated by a sufficient quantity of fresh or purified air?☐ Yes
        ☐ No
        Is your working area a

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