Employee Industrial Ergonomic Evaluation Questionnaire (For Employees)
Please complete this form in its entirety. An ergonomics specialist will be in touch following completion to schedule an evaluation.


This form is for NON-OFFICE job tasks only. To request an office ergonomic evaluation, click the below link.

Completion of this form will provide useful information to the ergonomics team and ergonomics specialist prior to the evaluation and after completion of the evaluation, the ergonomics specialist will utilize this information for the ergonomic evaluation report. This information may also be utilized during a post-evaluation questionnaire and post-ergonomic evaluation to determine the effect changes made had on discomfort levels (assuming changes are made).


This questionnaire is designed to be completed by a single employee requesting an evaluation. If you are a supervisor/manager/department head and would like to have an ergonomic evaluation of tasks your employees perform, please complete the Manager/Supervisor Ergonomic Evaluation Request - https://docs.google.com/forms/d/1b4ytpks8gcEYqWU6DrHsLhtcg0fivhoZA4jfK6Jk0HI/viewform

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