Standing Desk Medical Accommodation Request Form
Submit your request for a standing desk accommodation. Please provide all information needed to help us review and process your request efficiently.
Full Name
*
First Name
Last Name
Work Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Department
*
Please Select
Human Resources
Finance
Engineering
Sales
Marketing
Operations
Other
Supervisor or Manager Name
*
Job Title
*
Briefly describe your current workstation setup
*
Reason for Standing Desk Request (do not include sensitive medical details)
*
Describe any specific standing desk needs or preferences
Date of Request
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Request
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