Ergonomics Assessment Request Form

Prior to submitting a request for an office ergonomics assessment, please complete the Ergonomics Self-Assessment Checklist. The completed pdf can either be emailed to vanessa_christner@sfu.ca or uploaded with the form below.

Employee First Name

Employee Last Name

Employee Email Address

Supervisor First Name

Supervisor Last Name

Supervisor Email Address

Department

Have you completed the Self-Assessment Checklist (for office & shared work station assessments only) Yes No N/A

Upload Completed Self-Assessment Checklist

The total size of uploaded attachments can be no larger than 15MB

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Ergonomics Assessment Request Form

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