Ergonomic Assessment Request Please complete the form below to request an ergonomic assessment of your work space. Full name: * Employee ID number: * Email address: * Phone number: * Office location: * Please provide both the building name and room number. Supervisor: * Supervisor email address: * Supervisor phone number: * Why do you require an ergonomic assessment? * Leave this field blank This form will be sent to the Safety and Risk Management office and to your supervisor for authorization. You will also be sent an automated confirmation email for your own records. If you have any questions, please email us at firstname.lastname@example.org.