Office Ergonomics Assessment Form
Please fill out this form to help us assess your office ergonomics and improve your workspace comfort.
Full Name
First Name
Last Name
Job Title
Department
Do you experience any discomfort or pain while working?
Yes
No
If yes, please specify the areas of discomfort or pain.
How would you rate your current workstation setup?
1
2
3
4
5
What type of chair do you use?
Please Select
Ergonomic chair
Standard office chair
Stool
No chair
Do you use any ergonomic accessories?
Please upload a photo of your workstation (optional).
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Additional comments or suggestions
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