Revised on
10/21/16 01:59pm

Ergonomics Evaluation Request

Managers and supervisors are responsible for conducting ergonomic evaluations for their employees as per P&P 290-16. Participation by the manager/supervisor is required in order to perform an ergonomic evaluation of the employee's workstation. Employees desiring an ergonomic evaluation will need to contact their supervisor.

If you work at the UC Davis Medical Center in Sacramento, please contact Jill Evans-Grinbergs at 916-734-8377 or jill.grinbergs@ucdmc.ucdavis.edu to request an ergonomic evaluation of your workstation.

Section A: Supervisor Information
555-555-5555
Section B: Employee Information
555-555-5555
Section C: Type of Ergonomic Service Requested
Section D: Concern or Service Requested
Your Department Safety Coordinator's (DSC) Information
DSC lookup: http://safetyapps.ucdavis.edu/EHS/dsc/index.cfm