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Ergonomic Evaluation Request
     

If you would like to learn more about how to properly set up your workstation, fill out the form below.

Once we receive your request, we will send you a link to BruinErgo, UCLA’s online ergonomics training program and risk assessment survey. BruinErgo will help you to adjust your workstation to work more comfortably.

If you need help adjusting your workstation or determining equipment needs after completing the BruinErgo training, please contact us for follow-up.

 
    * Required Fields
    Employee Information:
    First Name*:
    Last Name*:
    E-mail*:
    Phone*:
    (310-794-5590) 
    Ext.
    Employee ID*:
    Job Title*:
    Department*:
    Address*:
    (Bldg. & Rm. No.) 
    Manager Information:  (Required for on-site services)
    First Name*:
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    E-mail*:
    Phone*:
    (310-794-5590) 
    Ext.
    Additional Information:
    Reason for Request*:
    Workers Comp
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