Revised on
10/01/19 01:38pm

Ergonomics Services 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 Health System in Sacramento, please contact Michael Galang at 916-734-8840 or to request an ergonomic evaluation of your workstation.
Section A: Supervisor Information
Files must be less than 2 MB.
Allowed file types: pdf docx xlsx.
Please download the form for the Tier 1 Ergonomics Evaluation
Section B: Employee Information
Section C: Type of Ergonomic Service Requested
Section D: Concern or Service Requested
Your Department Safety Coordinator's (DSC) Information
DSC lookup: