HomeFinance & AdministrationFinance & Administration OperationsRisk Management and InsuranceRisk ManagementWorkstation Evaluation Request Workstation Evaluation Request Workstation Assessment Request Name* First Last What department do you work in?Supervisor's Name* First Last What is your level of activity throughout the day?* Sedentary - sitting for most of the work day Lightly Active - sitting for most of the work day, but moving around at least once an hour Active - equal amount of sitting and moving Very Active - very little sitting, on your feet for most of the work day Does your current job require you to regularly lift more than 25 pounds or bend/stoop frequently?* Yes No Please indicate where you have pain or discomfort while at your workstation.* Head/headaches Neck/shoulders Elbows Hands/wrists Lower back Upper back Hips Knees Feet Have you been seen by a doctor or the Faculty/Staff Health & Wellness Clinic because of this discomfort? Yes No What are the specific concerns with your workstation? Is there anything the assessor should know prior to the assessment?Assessment Scheduling* Second Wednesday of the month, 2-4pm Third Thursday of the month, 9-11am Last Friday of the month, 2-4pm Assessments occur weekly on a rotating schedule. Please indicate which time frame is best for you. If you are not available during any of these times, we will reach out to schedule an assessment directly.CAPTCHANameThis field is for validation purposes and should be left unchanged.