1. Display Screen Equipment Training Presentation
Context
This presentation is designed to give an overview of the areas that must be considered regarding work with display screen equipment. 
It has been constructed for use by health and safety managers:
as a tool to outline the topic to team members/workers, or to line managers
as a guide to providing awareness of the topic to senior management/directors of the company.

2. Relevant Legislation and Guidance
Health and Safety (Display Screen Equipment) Regulations 1992
Health and Safety at Work, etc Act 1974
British Standards series: BS EN ISO 9241 Ergonomic Requirements for Office Work with Visual Display Terminals
Health and Safety Executive guidance:
L26 Work with Display Screen Equipment
INDG36 Working with VDUs
The use of display screen equipment (DSE) is covered by the Health and Safety (Display Screen Equipment) Regulations 1992 (as amended), which aim to promote the safe and effective use of DSE. Under the regulations, employers are required to:
perform a “suitable and sufficient analysis” of workstations to assess the health and safety risks to which users are exposed
plan users' activities so that daily work is periodically broken up by activity changes
provide DSE users with appropriate eye and eyesight tests at their request
meet the costs of tests and of any special corrective appliances prescribed
provide users with adequate health and safety training in the use of their workstations
inform users about the health and safety aspects of their workstations.
Under the regulations, employees should:
participate in training
advise employers where equipment is known or suspected to be defective
inform employers of any discomfort or health condition they suspect is caused or aggravated by DSE use
comply with safe systems of work, eg by taking regular screen breaks where the employer has deemed them necessary
co-operate with the employer in the use and care of items provided in the interests of health and safety, eg workstation accessories or spectacles provided for DSE use.

3. Ill-health Effects from DSE at Work
These may include:
musculoskeletal disorders (MSDs), or upper limb disorders (ULDs), eg aches and pains (back, shoulder, neck or wrist)
visual discomfort, eg eye fatigue and headaches
stress (mental and physical)
No matter how well designed an office may be, the use of DSE remains a major source of hazard leading to ill health, especially since advances in technology have led to the widespread and prolonged use of, if not dependence on, DSE within the workplace.
Despite the improvements to DSE workstations over the last years, there were still an estimated 84,000 new cases of work-related ULDs reported in 2008/09 (HSE). An estimated 3.5 million working days were lost in 2006/07 owing to ULDs, with each person affected taking over 13 days off sick. The DSE equipment itself is unlikely to create health problems, rather the way in which it is used may lead to MSDs, or ULDs, discomfort, fatigue or stress.
MSDs affect the muscular and/or skeletal structures of the body. Two main factors are associated with their onset.
Physical factors: poor or prolonged static posture, repetitive and forceful actions and insufficient rest or recovery time.
Psychosocial factors: high workload, low task variety, inadequate breaks and stress.
Jobs containing both factors increase the risks of ill health significantly. Work-related ULDs are a range of MSDs related to the work activities carried out by a person, eg discomfort, impairment or disability in the joints, muscles or tendons of the hands, wrists, fingers, arms and shoulders. Typical symptoms may include pain, swelling, restricted joint movement, loss of function or permanent disability.
The main causes of ULDs are seen as being:
repeating the same sequence of movements many times an hour or day, leading to repetitive strain injury (RSI)
static posture - sitting in the same position for hours on end
having to work very fast, under pressure
having to use appreciable force
lack of control over the order of tasks or working methods
working in awkward or tiring positions.
Neck and back discomfort are not uncommon in workers who sit for long periods to conduct their work tasks. Neck discomfort may be accompanied by discomfort in the shoulders and upper back.
Fatigue occurs when muscles cannot obtain enough energy to continue to function at the required capacity. For example, the lower back muscles quickly become fatigued when a person has to sit on a seat without a backrest. As the muscles become fatigued, the person slouches which, although temporarily comfortable, will lead to discomfort over time.
Visual discomfort: Many DSE users complain of eye strain (eg red eyes, sore eyes, a feeling of “gritty” eyes, difficulty in focusing and headaches) after prolonged periods of screen use. The internal muscles of the eye are responsible for focusing. When they become fatigued, they function at less than optimum levels and if the eye muscles are not rested, the user's visual ability may be lowered and the task becomes difficult to perform. Where visual defects are not corrected (eg through the adjustment of the display screen viewing distance or taking sufficient breaks from screen use), they can make work with DSE more tiring or stressful than it would otherwise be.
Symptoms of stress, eg irritability, anger, aggression, depression and anxiety, can arise leaving the person less rational and less able to cope with the stressful circumstance. The health and performance of the person are likely to be affected over the short and long term.

4. Hazardous Working Practices
Working with a poor posture
Working for too long without a break or change of position
A poor working environment
Poor management of workload
The DSE Regulations require the employer to encourage rest breaks and changes of activity. It is easy for users to get absorbed in their work and continue to work on past the point at which they would normally or should stop. Other than in emergency situations, or those where continuity is paramount, users should not extend their working time before a break or change of activity.

5. DSE Equipment DSE equipment includes: the screen the mouse
the keyboard
the central processing unit
portable DSE, eg laptops, notebooks and handheld computers
Screens should:
be adjustable in tilt, height and should swivel
have brightness and contrast controls
be placed directly in front of the user, at eye level.
The repetitive nature of mouse use can lead users to experience discomfort in the wrist. There is no recognised data to suggest any specific design of mouse is best but those who experience discomfort using one type of mouse may benefit from trialling alternative shapes and styles.
The keyboard should be:
adjustable in angle, to allow some change in height
a suitable size for the task
positioned directly in front of the user when in use.
The central processing unit, or the hard drive, should:
not restrict leg or foot space when placed on the floor
be easily accessible to the user every time they need to access an on/off switch or other disc drives
not be sited under the screen if it makes the height of the screen unsuitable for the user.
HSE research indicates that users of portable DSE are at no greater risk of developing health problems than those who use desktop versions. The principal risk of injury comes from:
the carrying/manual handling of a computer and other items of equipment
using portable computers in less than ideal locations, eg in vehicles or hotel rooms, where the seating position might not be adequate to avoid injury.

6. Display Screen Users
“Users” are those who habitually use a display screen as a significant part of their work
High-risk users: use DSE all day, every day
Moderate-risk users: use DSE a few hours a day
Low-risk users: use DSE for short periods but not every day
The definition of a “user” excludes:
students
members of the public
those who do not input or extract information using DSE
those who distribute or service DSE.

7. DSE Assessments When carrying out a DSE assessment, ask the following
Are the screen and mouse correctly positioned?
Is the chair properly adjusted?
Is the screen free from glare?
Are sufficient breaks away from the screen being taken?
Is the software suitable for the competence of the person using it?
Under the DSE Regulations, employers are required to conduct risk assessments to identify any hazards and recommend risk reduction measures for these hazards. They must be conducted for any person who uses DSE as a significant part of their work.
The assessment should:
be systematic
be comprehensive, covering work organisation, workplace and factors specific to individuals
include information (provided by both employer and worker) regarding any hazards found, the likely risk, any changes made during the assessment and any changes required.
The assessment should be recorded. It should also be reviewed if:
there have been significant changes in any of the elements of the workstation (eg the user, equipment, furniture, hardware or software, or following a desk move)
there is reason to suspect the original assessment is invalid
the user requests it
the user reports discomfort arising from their DSE work
the user reports the onset of a health condition or disability that could put them at increased risk.
Where a workstation is in temporary or short-term use, a risk assessment must still be conducted. However, it need not be recorded unless the risk is significant.
Employers can also use or provide simple checklists for their users to remind them of the required working arrangements and help them identify any problems. A good checklist will ensure that all the minimum requirements are covered. There are also numerous software packages which enable a company to train their DSE users and keep track of the assessments for any number of employees. However, any software package should be supplemented by trained DSE assessors, as they can complete assessments in-house and ensure adjustments are made. Help from external ergonomists may be required for more complex assessments.

8. Correct Posture [1] Check the following to ensure correct posture
Is the chair at the right height?
Is the display/screen at the right height?
Are the arms horizontal with the keyboard?
Is the backrest adjusted to support the back?
Is the user sitting in an upright position?
A suitable chair height enables the user to establish a comfortable arm posture for keyboard work. The chair should be adjusted so that:
the fingertips are level with the home keys on the keyboard
the wrist and forearm are horizontal (or parallel with the work surface)
the wrist is in a neutral position, not deviated up or down
the elbow is by the side of the body
the shoulders are relaxed
the user is sitting in an upright position
the backrest provides adequate support for the back.
The screen height should be:
adjusted so that the top part of the screen is level with the user’s seated eye level
raised or lowered according to the height or needs of the user, eg if the user wears bifocal or varifocal lenses, the screen can be lowered slightly to ensure a good neck posture.

9. Correct Posture [2] Back: upright and straight Elbow: 90 degree angle
Seat: level with knees
Feet: flat on floor or on footrest

10. Layout of the Work Area [1]
Poorly positioned and organised workstations can add to the risk of ULDs, so consideration must be given to the appropriate arrangement and set up of DSE, the workstation and equipment in order to improve the user's comfort and effectiveness. This includes the selection of peripheral items for use with DSE, eg:
document holder: a suitable holder should position the documents as close to the screen as possible, or between the screen and keyboard, minimising any bending and twisting of the neck; holders can be screen attachable or free-standing
screen filter: include mesh, glass and polaroid filters to reduce glare; filters should be used as a last resort as they can result in poor contrast
wrist rest: should only be used to rest the hand when not typing otherwise it may place pressure on the underside of the wrist, causing discomfort
monitor arm: can enable the position of the screen to be altered; a good monitor arm should allow adjustment for height, tilt (screen angle) and swivel (side to side).
Screen intensive: suitable for users who look at the screen most of the time

11. Layout of the Work Area [2]
Document intensive: suitable for touch typists who refer to the screen only occasionally

12. Checklist for Users [1] Adjust the chair for a good posture Check:
seat height and tilt
seat pad or back support for angle and position
arm rests (if present)
wrist support
After adjusting seat height for correct keyboard height, a footrest may help to reduce pressure on the thighs and allow a better sitting position
The chair backrest should be:
adjusted to support the lower back; if it is too low, the user may be pushed forward on the seat and have a tendency to slouch, leading to back discomfort
tilted to suit the user, at a suggested angle of between 90° and 100° and so that users do not recline too much in the seat (which would require the arms to be raised and stretched forward to reach the keyboard, and lead to the discomfort of and fatigued shoulder muscles).
A foot rest should be used where the user is unable to place their feet flat on the floor once the chair has been adjusted to the appropriate/comfortable working height. It must have a surface area large enough to support both feet.

13. Checklist for Users [2] Adjust the keyboard Check:
position
height
slope
Adjust the display screen Check:
distance, angle and height
glare and reflections
A gap of approximately 50–100mm should be left in front of the keyboard so that the user can rest his or her hands when not typing. A number of companies have produced ergonomic keyboards with a curved shape and/or with some of the keys slightly raised, in order to promote a better wrist posture. However, these are usually better suited to touch typists.
When in use, the screen should be directly in front of the user, so that the head is not tilted or twisted to either side. With multiple screens, the position should be as close to the centre as possible to minimise neck movement in any direction.

14. Checklist for Users [3]
Adjust the worktop layout to your work so that it is suitable for the task
Ensure that the mouse is in a suitable position
Move the keyboard if you use it less than the mouse
Check that you are comfortable
Excessive bending, twisting or pressure on the wrist used to operate the mouse can lead to discomfort and RSI. Breaks from mouse use, transferring the mouse between the left and right hand where possible, or changes of activity should be encouraged to ensure the wrist, arm and shoulder are relaxed and rested at frequent intervals.
A mouse which supports a horizontal wrist posture will be more suitable for use, as it prevents users resting their wrist on the table (which leads to deviation of the wrist upwards, creating pressure in the wrist itself). Some mouse mats also incorporate wrist rests.
Keeping the upper arm close to the body and the mouse within the hand's reach will help to prevent the user stretching to reach the mouse, which can relieve strain on the neck and shoulder muscles.

15. Using the Workstation
The risk of ill health is related to how the workstation is used
To reduce the risk:
change posture regularly
break up display screen work
manage the workload
organise the workstation
maintain a good working environment
It is important to understand the differences between a workstation and DSE, as the two terms are often used interchangeably.
DSE describes almost all types of screen used at work, including those used to work with television or film pictures. (It does not include devices with small screens, such as mobile phones or PDAs.) Workstations are an assembly made up of:
DSE
any peripheral equipment, eg input devices (keyboards, mice) and hard drives
telephones, printers and other equipment
the work chair
the work surface
other furniture, eg footrests and storage pedestals
the immediate work environment, eg lighting, noise, temperature.
Most office-based computers are regarded as DSE.

16. Avoiding Health Problems
To avoid health problems:
ensure the workstation is set up correctly
ensure the work is organised properly
ask for an eye test if you have problems with your vision
adopt a good posture and change position regularly — take exercise
report aches and pains or ill health
Regulation 5 of the DSE Regulations states that users, whether they are already users or about to become so, should be provided with appropriate eye and eyesight tests at their request. The employer must meet the costs of tests and of any special corrective appliances prescribed to adjust visual quality at the DSE viewing distance, where normal appliances (eg spectacles or contact lenses) cannot be used. Further sight tests must be provided for the user at regular intervals or if the user experiences visual difficulties considered to be caused by DSE work.

17. Supervisors’ and Managers’ Responsibilities
Supervisors and managers must:
be aware of their organisation’s policies and rules for health and safety
ensure users follow safe systems of work and good practice
promptly follow up reports of problems or ill health
report problems they cannot deal with
lead by example
Employers have a legal duty to prevent work-related ULDs or to stop any cases getting worse. All employers should have in place a clear policy in relation to the safe use of DSE, and a system to detect and manage any cases of ill health that arise from DSE use, eg MSDs and ULDs. To be effective, this system should include the following procedures.
Encourage users to report any symptoms early. Early detection and treatment will help in the avoidance or development of any serious problems.
Provide appropriate advice for users who report the symptoms. This could include providing a supportive climate, advice of risks and measures to avoid future problems.
Provide referral to health professionals for diagnosis, treatment and further advice.
Assist sufferers to continue work or to return to work after periods of absence. This may include alterations to workstations, work patterns and additional support.
Ill health caused by DSE can be successfully managed in the workplace by:
assessing risks by examining the workplace to see which jobs may cause harm
reducing risks by changing the way work is organised
ensuring keyboard work is alternated with other tasks requiring the use of different muscles
ensuring that regular breaks are taken
ensuring that workloads and deadlines are reasonable.

18. Training Training and information should cover:
the risks of all health hazards (MSDs, ULDs, RSI, etc) and how they can be minimised
correct posture to be adopted at the keyboard
the importance of taking breaks
the reporting of signs and symptoms of ill health
Regulation 6 of the DSE Regulations requires that users be provided with adequate health and safety training in the use of their workstations. In practice, training should:
ensure users are familiar with the setup and adjustments of their workstation
ensure users are aware of good ergonomics practice, including the need to take regular breaks from DSE use
aim to reduce or minimise physical problems, particularly MSDs, ULDs visual fatigue and mental stress
cover aspects such as:
posture
equipment (eg work chair, screen, keyboard and mouse)
work space (eg storage)
environment
lighting
software
work organisation (eg breaks)
the causes of risk and the ways in which harm may occur
how employers assess workstations, reduce risks and comply with minimum requirements
what arrangements are made to provide eye tests, glasses for VDU use and health and safety training
the DSE Regulations and user entitlements.
Further training should be given whenever the organisation of a workstation is substantially modified.
A proactive training approach should focus on prevention rather than cure. Many DSE users will adopt bad habits if not encouraged to avoid static postures, repetitive actions, etc, so training and information needs to be provided in a way that encourages people to know the risks, accept their own duty of care to themselves and take responsibility for their own health and safety at work. Information should be brought to the user in a way so that the benefits can clearly be seen, including keeping users aware of what they should do and how their employer can help them.
Training should also be provided for employees who will assess DSE workstations. In addition to the information provided to other employees, assessors will also need to recognise risky workstation layouts, environments and practices. It is important to check that assessors have understood the information given to them and are competent and confident when carrying out assessments, although this usually comes with practice.

19. Summary To reduce risks associated with DSE:
the workstation must be set up correctly
the equipment must be used properly
the work must be suitably organised
users, supervisors and managers should be aware of possible health risks, follow procedures and work safely
users should report any problems to their supervisors or managers