Ergonomics Assessment Request
Please provide the following information in your request. This information begins populating the field form used during assessments:
Date of Request:
Building name where your office is located:
Have you had an Ergonomic Assessment before?
Work Schedule / Days Per Week
Indicate number of days per week worked. IE: 5 days per week.
Work Schedule / Hours Per Day
Indicate number of hours per day worked. IE: 8 hours per day.
Are you experiencing any physical symptoms?
Please indicate your affected body part and the type of symptom. IE: Lower back pain.
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