Use this form to request an Ergonomic Evaluation. Please fill it out to the best of your ability. This service is available to employees only. Please only fill this out AFTER completing your self-assessment on the following LINK. Name: * Email: * Contact Number: * Where are you located?: * Building name/number and room number. Type of Request: * Ergonomic workstation evaluation Seating Evaluation Information and demonstration of ergonomic office equipment Reason(s) for Request I experience discomfort (associated with my workstation) I have a new workstation or I am new to the job I want to ensure my workstation is set up ergonomically correct Other (please specify) Reason(s) for Request: Other (please specify) Have you submitted the RSS self assessment? * Yes No CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
