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<br />Addendum 1 <br />Self-Certification Home Safety Checklist <br /> <br /> <br /> <br />1. Is the workstation deep enough to accommodate the monitor and <br />keyboard directly in front of you, the User? <br /> <br />Yes No  <br />2. Does the workstation provide sufficient leg room (depth and width), so <br />that there are no obstructions for your knees, legs, shins, or thighs? <br /> <br />Yes No  <br />3. Is there adequate room for the monitor to be positioned 16 to 29 inches <br />from your eyes? <br /> <br />Yes No  <br />4. Do you have surge protectors for the equipment? <br /> <br />Yes No  <br />5. Are your forearms, wrists, etc. free from contact with hard, sharp <br />edges? <br /> <br />Yes No  <br />6. Is the chair stable? <br /> <br />Yes No  <br />7. Does the chair adjust in height? <br /> <br />Yes No  <br />8. Is there at least 3 inches between the front edge of the chair and the <br />back of your knees when sitting in the chair? <br /> <br />Yes No  <br />9. Does the chair provide lower-back support? <br /> <br />Yes No  <br />10. Are your feet flat on the floor or on a footrest when sitting back in the <br />chair? <br /> <br />Yes No  <br />11. Are all phone lines, electrical, and other cords tied up and kept out of <br />the way? <br /> <br />Yes No  <br />12. Are all stairs with 4 or more steps equipped with handrails? <br /> <br />Yes No  <br />13. Is there adequate light for reviewing the monitor and for reading <br />printed materials? <br /> <br />Yes No  <br />14. Is the monitor screen positioned so that there is no glare? <br /> <br />Yes No  <br />15. Do you avoid clutching the phone receiver between your ear and <br />shoulder? <br /> <br />Yes No  <br />16. Are aisles and doorways free of obstructions? <br /> <br />Yes No  <br />17. Are all electrical cords in good condition? <br /> <br />Yes No  <br />18. Is all electrical equipment in good working condition? <br /> <br />Yes No  <br /> <br /> <br />Employee Signature _________________________________ Date____________