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Workplace Ergonomics Complaint Form - Free Operations Template | ZenBuild | ZenBuild

Templates→Operations→Workplace Ergonomics Complaint Form

Workplace Ergonomics Complaint Form

Allow employees to report ergonomic discomfort or injury risks at their workstation and request an assessment.

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Workplace Ergonomics Complaint Form

Allow employees to report ergonomic discomfort or injury risks at their workstation and request an assessment.

Employee Name*

Employee Email*

Department*

Workstation Location*

Type of Discomfort*

Description of Discomfort or Issue*

How Long Has This Been a Problem?*

Equipment Contributing to Issue

ChairMonitor HeightKeyboard PlacementMouseDesk HeightLightingFootrest Needed

Has This Caused You to Miss Work?*

YesNo

Proposed Adjustments Needed

Template Details

CategoryOperations

Fields10

Uses0

Views1

ergonomicssafetyworkplace