Stanford University: Ergonomic Equipment Matching Fund

ANNOUNCEMENT: To help clarify and expedite the process, there have been several changes made to the Ergonomic Equipment Matching Fund. For details, click and read the Ergonomics Matching Fund webpage. These changes are immediately in effect starting December 15th, 2024.

The Ergonomic Equipment Matching Fund is a partnership program between Risk Management Services and Stanford Environmental, Health, & Safety Department to optimize ergonomics for computer workspaces. The program aims to encourage departments to support their employees’ ergonomic needs by offering a financial reimbursement for ergonomic equipment.

Intended for Stanford University faculty and staff who purchase EH&S-approved ergonomic equipment may be eligible for 50% matching funds reimbursement up to a maximum of $300 over the course of their employment. Ergonomic equipment must be on the pre-approved products list or recommended by the Stanford Ergonomics Program in a report/email. No other equipment will be accepted.

Pre-Approved: Computer Ergonomics Equipment Product List

For requests to be processed all the necessary and accurate information must be submitted. If not, the request will be denied. The following will be needed to complete the form::

Submit iJournal transfer. Write down the iJournal number as it will be needed to complete the form. Please refer to the Fingate iJournal webpage for information on how to complete an iJournal
The employee’s job code which can be provided by their local HR representative.
Employee’s Certificate of EHS-3400 Computer Workstation Ergonomics training (from STARS)
PDF copy of the A) employee’s Self-Assessment Tool, B) Ergonomic Evaluation Report, OR C) Ergonomic Showroom Email
Copies of invoices/receipts for the equipment purchased

The Matching Fund Program is available for purchases made in the current fiscal year from Sept 1 - July 15 or until all established funds are depleted.

For current program details and FAQ, please visit the Ergonomics Matching Fund Webpage.

Reimbursement Information

Entity

Department Name

iJournal No.

Please ensure an iJournal is submitted before filling out this form. (ex. ij2009791)

Employee's First and Last Name

Employee's Job Code

Enter employee's job code (ex. 8591). Can be provide by Local Human Resource representative.

Employee's Job Title

Employee's Phone Number

Phone

Employee's Email Address

Supervisor's First and Last Name

Supervisor'sPhone Number

Phone

Supervisor's Email Address

Equipment For Reimbursement Request

Equipment must be from the EH&S pre-approved computer ergonomics product list. Enter brand and model of each item and the cost. Receipts, POs, and/or Invoices must be submitted and attached to the iJournal reimbursement request and to this form in order to be processed. Reimbursement requests that are incomplete may be denied and/or may delay processing.

Please Indicate the Type of Ergonomic Equipment you Would Like to Purchase.

How Many Items are Included for this Reimbursement Request?

Total Cost of all Equipment on Reimbursement Request

Total cost must match total cost shown on PO, invoice, order, requisition, and/or receipts

Partial Reimbursement Amount

=50% of Total Cost, not to exceed $300. (i.e. if total cost of equipment is $500, max reimbursement is 50%, or $250; if total cost of equipment is $800, max reimbursement is $300).

First and Last Name of Person Submitting Form

Submitter's Phone Number

Phone

Submitter's Stanford Email Address

File Upload

Upload supporting documents to this form: 1 - computer ergonomics self-assessment form -OR- the EH&S ergonomics evaluation report performed by the ergonomics specialist 2 - a copy of PO, receipt or invoice for each item as proof of purchase Note: these items must match the iJournal transfer request in order to be processed.

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