Home Office Safety Self-Assessment Form

Employee Information

Name Position Date

Is the work area free from clutter, tripping hazards, and obstructions?

Yes No

Is there adequate lighting in the workspace?

Yes No

Is the chair and desk ergonomically appropriate?

Yes No

Are electrical cords in good condition and not running under rugs or furniture?

Yes No

Are outlets not overloaded?

Yes No

Is there a working smoke detector near the workspace?

Yes No

Is emergency contact information readily available?

Yes No

Is there an accessible first aid kit?

Yes No