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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.

These services are only available for UCLA campus employees. We serve all departments except those within the UCLA Health System.

UCLA Health System employees: Please contact Jason Barry for further ergonomic assistance.

Check with your supervisor/department if you are unsure if you belong to School of Medicine or the Health System. A number of medical-related departments consist of both School of Medicine employees and Health System employees.
 
    * 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*:
    Last Name*:
    E-mail*:
    Phone*:
    (310-794-5590) 
    		 Ext.
    Additional Information:
    Reason for Request*:
    		 Online Training (BruinErgo)
    On-Site Workstation Evaluation
    Ergonomics Lab Visit
    Workers Compensation
    Occupational Health Facility (OHF) Referral
    Other
    Comments: