Eye Care form

Managers must complete the below form where an employee is identified as a habitual user of Visual Display Units and or Display Screen Equipment. The employee must complete a DSE Self-Assessment and discuss reasonable adjustments with their line manager in addition to submitting this form. In the first section, please input your staff members details.

Staff members full name Required

Job title Required

Email address Required

Ward or Department Required

Payroll number Required

Manager details

Please input your details below.

Full name Required

Budget code Required

Directorate or Division Required

Are you the line manager? Required

I can confirm that I am a line manager for the person mentioned above.

DSE self-assessment

I can confirm the person mentioned above has completed a DSE self-assessment and has been identified as a habitual user of either display screen equipment or visual display units.

I agree to the privacy policy

Eye Care form

Manager details

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Eye Care form

Manager details

Quick links

Popular pages

CQC rating

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