INSTRUCTIONS:

This form is for UCSF CAMPUS staff and faculty only.

Complete this form for ergonomics requests involving MORE THAN TWO Campus staff and faculty members.

BEFORE proceeding:

• Confirm employment status is UCSF CAMPUS.
• Review Which Ergonomics Program Should I Contact?
• UCSF Health employees should not use this form. Contact UCSF Health Ergonomics instead.
• If your group involves UCSF Campus and other types of people, provide details in the form.
• Identify the initial primary contact person.
• This person may be a manager, supervisor, or someone who will coordinate on behalf of their group.
• Have photos ready to submit, if these would be helpful.

NEXT STEPS:

• After reviewing your form, we will contact the primary contact person with guidance about how the group should proceed.

Thank you for submitting this inquiry to the UCSF Ergonomics & Human Factors Program.

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