UCSF Campus Ergonomics Inquiry Form - Individuals

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. Photos clearly show any issues you need help with
  6. Have completed ERGONOMICS TRAINING and reviewed results with your supervisor/manager.
  7. Log into MyAccess to access training.
  8. Need assistance with PREVENTIVE or NON-OCCUPATIONAL ergonomics (NOT work-related pain or injury).
  9. Refer to the three Pathways for Ergonomics Assistance.
  10. You need to select one pathway to proceed.
  11. Do not use this form for requests related to work-related pain or injury as different processes apply.
  12. 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.

All four boxes must be true and checked for this inquiry to be processed.


If you do not meet all four criteria, STOP. Do not submit this form. Refer to the instructions on this form to determine how to proceed. Incomplete forms will be returned to employees and their supervisors.

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If no personal pronouns are provided, "they, them, theirs" will be used as default in communications

Phone
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We need to see:


a) A photo of the workstation without you in it.

AND

b) Photos of YOU using the workstation shown from different angles


Submit the following:


  1. Overall view of your workstation(s)
  2. Side-view of you using your workstation(s)
  3. View of your workstation(s) from the back with you in it
  4. Remove any jackets from the chair backrest so the chair is visible
  5. Photos that clearly show what you need help with or that you think would be helpful.
  6. For example, you using your keyboard or sitting in your chair, or the room layout, equipment, or lighting
Drag and drop files here or

Example: 5 feet 9 inches

All seating options have a weight capacity.

Newer chairs rate at 300 pounds (lbs). Older chairs may rate at 225 lbs.

Safety issues may occur if your chair is rated at the wrong capacity for you.

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It is ok to estimate. Use a tape measure, ruler, or smartphone app.

Example: 29 inches

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Example: EH&S/Ergonomics

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