Get Mod Form 5016

Filling out the Mod Form 5016 online is essential for conducting a thorough DSE user assessment. This guide provides clear instructions to help you navigate the process effectively.

Follow the steps to complete your Mod Form 5016 online.

1. Press the ‘Get Form’ button to access the Mod Form 5016 and open it in your preferred digital editing tool.
2. Begin by entering your workstation location in the designated field. This helps in identifying the assessment context.
3. Fill in your name as the user and provide your signature in the appropriate section to confirm your input.
4. Record the relevant DSE workstation assessment reference number, ensuring it is accurate for future reference.
5. Indicate the average time your workstation is used per working day by selecting one of the provided options: less than 4 hours, 4 to 7 hours, or more than 7 hours.
6. Repeat step 5 for your average time of domestic DSE use, specifying whether it is less than 1 hour, 1 to 2 hours, or more than 2 hours.
7. Calculate and note the total average time DSE is used per working day by choosing the relevant option from the list.
8. Select your DSE user assessment type by marking whether it is for office, home/remote, or portable use.
9. Provide the name of your line manager and ensure their signature is recorded in the respective section.
10. Enter the date of the assessment, making sure this information is clear and accurately reflects when the evaluation was conducted.
11. Consider whether any further action is required based on the assessment findings and document this in the specified section.
12. If applicable, note the follow-up action completion date and ensure that the validity duration does not exceed two years.
13. Once all relevant sections have been filled out, review your entries for accuracy before saving your changes, downloading, printing, or sharing the completed form.

Complete your Mod Form 5016 online today to ensure a thorough and effective DSE user assessment.