Main Page   Policy   Appendices A-1: ITA Telework Application and Agreement A-2: ITA Telework Safety Checklist A-3: ITA Telework Termination Form A-4: Telework Screening Guidelines A-5: Guidance for Identifying Jobs/Duties in ITA Suitable for Telework A-6: Federal Telecommuting Centers

International Trade Administration Telework Appendices TELEWORK SAFETY CHECKLIST Note: This checklist is to be completed only if the proposed alternate workplace is located in a private residence. This checklist is designed to assess the overall safety of the designated work area of the alternate workplace. Each applicant should read and complete the self-certification safety checklist. Upon completion, the checklist should be signed and dated by the applicant. Applicant:                                                                                            Telephone: Location of alternate workplace:                                                       Telephone: Describe the designated work area: Within the designated work area: Are all stairs with four or more steps equipped with handrails? Yes No N/A Are all circuit breakers and/or fuses in the electrical panel labeled as to intended service? Yes No N/A 3. Is all electrical equipment free of recognized hazards that would cause physical harm (frayed wires, bare conductors, loose wires, flexible wires running through the walls, exposed wires fixed to the ceiling)? Yes No N/A 4. Will the building’s electrical system permit the grounding of electrical equipment? Yes No N/A 5. Are aisles, doorways, and corners free of obstructions to permit visibility and movement? Yes No N/A 6. Are file cabinets and storage closets arranged so drawers and doors do not open into walkways? Yes No N/A 7. Are the chair casters (wheels) secure and the rungs and legs of the chair sturdy? Yes No N/A 8. Are the phone lines, electrical cords, and extension wires secured under a desk or alongside a baseboard? Yes No N/A 9. Is the office space neat, clean, and free of excessive amounts of combustibles? Yes No N/A 10. Are floor surfaces clean, dry, and level? Yes No N/A 11. Are carpets well-secured to the floor and free of frayed or worn seams? Yes No N/A 12. Is there sufficient light for reading? Yes No N/A Computer Workstation (if applicable): Is your chair adjustable?       ___Yes       ___No Do you know how to adjust your chair?       ___Yes       ___No Is your back adequately supported by a backrest?       ___Yes       ___No Are your feet on the floor or fully supported by a footrest?       ___Yes       ___No Are you satisfied with the placement of your monitor and keyboard?       ___Yes       ___No Is it easy to read the text on your screen?       ___Yes       ___No Do you need a document holder?       ___Yes       ___No Do you have enough leg room?       ___Yes       ___No Is the screen free from noticeable glare?       ___Yes       ___No Is the top of the screen eye level?       ___Yes       ___No Is there space to rest your arms while not keying?       ___Yes       ___No When keying, are your forearms close to parallel with the floor?       ___Yes       ___No Are your wrists fairly straight when keying?       ___Yes       ___No By signing this document, the applicant certifies that all of the above applicable questions were answered in the affirmative or, if answered in the negative, that the applicant will take all necessary corrective actions to eliminate any hazard (as revealed by a negative response) before (s)he begins to telework. _______________________________       __________ Applicant’s Signature                                     Date