Ergonomics

Please complete and submit this form to request an ergonomic evaluation, and inform your HEERA Manager of this evaluation request. Cal Poly Pomona Ergonomics will contact you within 2 weeks to schedule the assessment.

If no, STOP and do NOT complete this form. Please contact your campus employer (Foundation or ASI) for assistance.

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About Your Request

Please do not provide Protected Health Information.

If requesting a home office evaluation, please submit a couple of home workstation photos using the upload field provided later in this form.

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Select from drop down menu or type in reason.

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Please provide a brief description detailing the reason for your evaluation request.* Do NOT document any protected health information.

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Contact and Job Information

Select your campus division from the drop down menu.

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Example: (000) 000-0000

If assessment is for telecommute/remote work, please type in "home"

Example: M-Fri (8-4:30pm), Remote Tuesday/Friday, etc.


Ergonomics Training

If no, please complete the applicable Ergonomics training on SumTotal, as listed below: -CSU - Computer Workstation Ergonomics -CSU - Manual Material Handling Ergonomics for Custodians -CSU - Manual Material Handling Ergonomics for Landscape Services Employees -CSU - Manual Material Handling Ergonomics for Trades Employees To access SumTotal please visit https://csu.sumtotal.host/core/dash/home/Home_Pomona> and login. Search ergonomics to find the above training programs.

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Workers' Compensation Information

As a Cal Poly Pomona employee, student assistant, or volunteer, if you sustain an injury or illness that you feel was caused by your work, please contact Workers' Compensation. Below is a link to their website. CPP Workers’ Compensation Website at http://www.cpp.edu/workers-comp Obtain a Claim Form from your supervisor or the Workers’ Compensation Coordinator.

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Work Restrictions and Accommodations

Employees seeking disability support and accommodation should contact the ADA Coordinator. This includes, but is not limited to sit/stand desks, which cannot be obtained through an ergonomic evaluation. Contacting the ADA Coordinator: https://www.cpp.edu/eoda/employee-labor//access-accommodations/ada-coordinator.shtml


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