Workplace Ergonomics Check-In Form
Please complete this form to help us assess and improve your workplace ergonomics.
Full Name
First Name
Last Name
Department
Please Select
Human Resources
IT
Finance
Marketing
Operations
Customer Service
Sales
Administration
Do you experience any discomfort or pain while working?
Yes
No
If yes, please describe the discomfort or pain
How would you rate your current workstation setup?
1
2
3
4
5
What ergonomic improvements would you suggest?
Submit
Should be Empty: