UC Berkeley

Be Well at Work - Ergonomics

Ergonomic Request Form:

Evaluations & Project Consultation

This is the form for UC Berkeley faculty and staff to request ergonomic assistance from Be Well at Work - Ergonomics campus ergonomists. Ergonomics provides individual & group evaluation and ergo project consultation assistance for computer and non-office work environments.


Computer Ergonomics:

UC Berkeley employees should first complete the RSS Computer Ergonomics Self-Assessment & Training online module as outlined on the Be Well at Work - Ergonomics website.

The ergonomics tips provided in the module should be reviewed and implemented. Completion of the module also grants eligibility to UC Berkeley faculty/staff for Be Well at Work - Ergonomics' Matching Funds program. Requesters who have not completed the module will be redirected to finish it first.


Non-Computer Ergonomics:

UC Berkeley's campus has a variety of work environments beyond computer workstations ranging from food service and housing to custodial, facilities, trade shops, laboratory, and medical/clinical. We provide ergonomic guidance for improving these work environments to help departments protect our faculty and staff from harm.

For staff involved in non-computer work areas and tasks, you can complete the online Back Safety (Smart Body Management) module as an initial resource on general ergonomic body mechanics before the scheduled evaluation.


Project Consultations:

Be Well at Work - Ergonomics provides consultation for departments looking to make wholesale ergonomic improvements to computer and/or non-computer work areas and furniture/equipment. Projects can provide potential savings benefits to departments via bundling items for potential further unit cost discounts as well as reduced installation and delivery costs. Ergo Project Matching Funds can be discussed pending eligibility and availability.



Providing detailed responses to all questions and including photos and measurements (where applicable) will allow us to better understand your challenges and assist you appropriately.


As needed, evaluations/consultation discussions may be scheduled and conducted virtually via Zoom (i.e. remote work setup).


For questions, please email ergonomics@berkeley.edu.

Non-computer encompasses but is not limited to: custodial, food service, facilities, trades, laboratory, clinical, etc.


Department Project consultations are for requests including but not limited to assisting departments with evaluating design/redesign of work areas, higher-level overview task analysis, acquisition of higher quantity quotes for ergo furniture/equipment, etc.

Online Ergo Self-Assessment & Training Completed?*

If answering "No", please refer to the information described in the instructions panel to the left to access the online RSS ergo self-assessment and training module.

Add preferred/nickname in parenthesis.

Phone
Position Classification*

First & Last Name

Phone
Working Location*

Provide location details:

  • Building Name and/or Street Address
  • City (if outside of central campus footprint)
  • Floor/Suite/Room etc.

Provide the city and state where you are located. This will help with providing guidance on ergo product acquisition.

Your percentage split and days & time spend on campus versus remote.

Campus Computer Workstation Description*

Select the option that describes your workspace.

Select all options that describe the work area and/or tasks performed.

If you selected other, briefly summarize/describe your work/tasks.

Reason for Request*

Please provide a brief overview detailing the reason for your evaluation request (workstation & task descriptions, issues, discomfort, work accommodations/restrictions, etc.).

Are you the primary project lead/manager?*

First & Last Name

If applicable: add preferred name in (parenthesis)

Phone
Project Lead's Position*

Select all that apply if the project will span multiple categories.

If not one of the selectable categories, briefly note what the project other project type.

List applicable campus building/address location(s) where the project(s) will take place.

Anticipated number of employees this project will benefit.

When you are looking to have the project completed.

Your projection of what the project will cost and/or how much budget your department has discussed allocating.

Has any project consultation already occurred?*

Ex: project management group/vendor/distributor

List the names of the other groups/companies you have preliminarily consulted with.

Provide a descriptive overview of the project.

Preliminary photos help the ergonomist get an initial look at the existing work environment and the setup. Please provide:


For computer evaluations provide:

1) A photo of the entire workstation/work area (including the chair if a computer setup)

2) A second side profile photo of you sitting/working at the workstation that captures your entire body and workstation/work area (recommend having another person help take the photo)

3) If your request is for a remote/home workstation, please fill out the remote ergo evaluation measurements form that will provide the ergonomist reference workstation measurements for a virtual ergonomic evaluation. Attach the file here in addition to providing photos.


For non-office evaluations or project consultations:

Provide photos of the area(s) to provide the best preview of the existing space and equipment/furniture as possible.

Drag and drop files here or

Select the days of the week you are available to schedule an evaluation.

Remote evaluations will be scheduled and conducted via Zoom.

Provide your times of the day you are available for scheduling the evaluation (ex: between 9-11am PT).

Provide any specific planned date(s)/date range(s) you will be unavailable to schedule (answer 'none' if not applicable).

Years at UC Berkeley*

How many years have you worked at UC Berkeley?

Prior Evaluations*

How many prior ergonomic evaluations have you had while employed at UC Berkeley?

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