Form 151
Oct 2013
Page 1 of 3
Members of Parliament (Staff) Act 1984 Employees
WORK HEALTH AND SAFETY CHECKLIST
WORKING FROM HOME OR FROM A PRIVATELY-FUNDED OFFICE
Do NOT return your completed form to Ministerial and
Enquiries: Staff Help Desk
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.
Privacy Statement — Information is collected by the Department of Finance primarily to enable the administration and payment of Parliamentarians’ entitlements and
salary, and the entitlements of staff. The collection, storage and use of the information contained in this document is governed by the Privacy Act 1988 and the Freedom
of Information Act 1982. Some information may be provided to the Special Minister of State and may also be tabled in Parliament. It may be released as required by law.
More information on collection, storage and use of personal information is available at
The Work Health and Safety (WHS) Checklist is designed to help MOP(S) Act employees and managers to assess WHS risks in the home office
or in a privately funded 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 or their authorised person.
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