Get the free Ergonomic Assessment request form - Grand Valley State University

GVSU Request for Ergonomic Evaluation Individualized Work Station Evaluation Individualized Work Station Evaluations conducted by GVSU Occupational Science and Therapy Faculty are offered at no cost

How to fill out ergonomic assessment request form

How to fill out ergonomic assessment request form

1. Step 1: Start by downloading the ergonomic assessment request form from the official website.
2. Step 2: Read the instructions provided in the form carefully to understand the information required.
3. Step 3: Begin filling out the form by entering your personal details such as name, contact information, and employee ID.
4. Step 4: Provide details about your current work setup, including the type of furniture, computer equipment, and any additional accessories you use.
5. Step 5: Describe any pain or discomfort you are experiencing and specify the areas of your body that are affected.
6. Step 6: Indicate the tasks you perform regularly and the duration of each task during your workday.
7. Step 7: Answer any additional questions or provide any other relevant information requested on the form.
8. Step 8: Once you have completed filling out the form, review it to ensure all necessary information is included.
9. Step 9: Sign and date the form to certify its accuracy.
10. Step 10: Submit the form to the designated person or department responsible for handling ergonomic assessments.

Who needs ergonomic assessment request form?

1. Employees who experience discomfort or pain while performing their job tasks.
2. Individuals who use computers or other equipment for prolonged periods as part of their work.
3. Workers who have recently undergone any physical changes or surgeries that might affect their ability to perform tasks comfortably.
4. Employees who are required to perform repetitive motions or maintain fixed postures for extended periods of time.
5. Individuals who have been diagnosed with musculoskeletal disorders or have a history of such conditions.
6. Workers who wish to improve their working conditions and prevent potential health issues related to ergonomics.

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What is ergonomic assessment request form?

Ergonomic assessment request form is a document used to request an evaluation of a workspace to identify and address potential ergonomic issues.

Who is required to file ergonomic assessment request form?

Any employee who is experiencing discomfort or pain related to their workspace is required to file an ergonomic assessment request form.

How to fill out ergonomic assessment request form?

To fill out the ergonomic assessment request form, employees need to provide details about their workspace, describe their discomfort or pain, and submit the form to their employer or HR department.

What is the purpose of ergonomic assessment request form?

The purpose of ergonomic assessment request form is to improve the comfort, health, and productivity of employees by addressing ergonomic issues in their workspace.

What information must be reported on ergonomic assessment request form?

Information required on the ergonomic assessment request form includes details about the employee's workstation, any discomfort or pain experienced, and any specific requests for adjustments.