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Please fill out this form if you'd like an ergonomic assessment of if you'd like to replace existing furniture/equipment with ergo-furniture/equipment.
What is giving discomfort? What appears to be making it occur?
New discomfort in this area?
How long have you had this discomfort?
Did this occur at work?
Has this been brought to the attention of the University before?
Have you filed any workmen's compensation papers in the past?
Please make sure you have completed all fields marked with an asterisk in this form as they are required. Don't forget to print this form for your record before you submit it. Just select "Print" from the File menu in your browser.
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Last modified: March 16, 2017 22.214.171.124