INSTRUCTIONS:

This form is for UCSF CAMPUS staff and faculty only.

BEFORE proceeding, make sure you meet these FOUR CRITERIA:

1. Confirmed you are employed by UCSF CAMPUS*.
2. Are ready to submit at least THREE PHOTOS, using the instructions provided.
3. At least one of your workstation
4. At least two of YOU using your workstation
5. Have completed ERGONOMICS TRAINING and reviewed results with your supervisor/manager.
6. Log into MyAccess to access training.
7. Need assistance with PREVENTIVE or NON-OCCUPATIONAL ergonomics (NOT work-related pain or injury).
8. Refer to the three Pathways for Ergonomics Assistance.
9. You need to select one pathway to proceed.
10. Do not use this form for requests related to work-related pain or injury as different processes apply.
11. Contact your supervisor or Disability Management Services with questions and for guidance.

* To confirm your employment status:

1. Review Which Ergonomics Program Should I Contact?
2. UCSF Health employees should not use this form. Contact UCSF Health Ergonomics instead.

Thank you for submitting this inquiry to the UCSF Ergonomics & Human Factors Program. We will contact you if we need more information and for the next steps.

If you need assistance with digital accessibility as you complete this form, let us know.