Ergonomic Assessment Request

Please complete the request below and we will be touch very soon. Be sure to identify your preference between the web-based program and an onsite assessment.

Date of Request:

Last Name:

First Name:

Your Department:

Position Title:

Building name where your office is located:

Room number:

Email address & phone number

Have you had an Ergonomic Assessment before?

Select or enter value

Work Schedule: Days Per Week & Hours Per Day

Indicate number of days per week and hours per day worked.

Web-Based Training & Self-Assessment

A web-based training & self-assessment program is now available for office assessments. This may be a good place to start, if you are a new employee or unfamiliar with office ergonomics and not experiencing any physical discomfort. It takes approximately 30 minutes. Once completed, if you need further assistance, an onsite follow up assessment can be scheduled.

Would you like to use this program?

Any Information for the Assessment

If you have information you want to share prior to the assessment, please add it here.

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