Please complete the Online Office Ergonomic Training and review the Ergonomics Self-Assessment Check Sheet prior to submitting an Ergonomic Assessment Request - Many Ergonomic issues can be remedied utilizing these beneficial tools.   

If you are still experiencing pain/discomfort, please complete this form to request an Ergonomic Evaluation.  If you are not contacted within 5 business days, please contact the program manager at 994-7384 directly.

If your situation may be covered by the American with Disabilities Act, please contact MSU's Human Resources Officer - ADA Coordinator, Katarzyna (Kasia) Maison at 994-2629 or katarzyna.maison@montana.edu.

 

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My Information
My Supervisor's Information
Office Computer Workstation Questionnaire
Laboratory Environment Questionnaire
Please proceed to the "Your Working Conditions" section below.
Your Working Conditions
Example: I have a dull pain in my lower left back that radiates up. The pain is about the size of a quarter when it starts, then it radiates in the size of a dime.
Example: I am typically answering phones consistently and trying to research information while I am on the phone. It typically starts around 11am.
Example: It gets better when call volume is lower, and after I get up and stretch. It gets worse when I don't have time for breaks.
Example: It happens almost daily.
Example: It started about 3 weeks ago. I took the online training and completed the self-check, making adjustments with my Supervisor, however, it's been over 2 weeks and it hasn't gotten better.
Historical Information
Example: "6/24/2016" or "Summer of 2017"
Example: We modified my desk height, monitor height, tried 3 different mice and concluded that a vertical mouse was best, and adjusted my chair. It got better for 4 weeks, then it returned.
Medical History
Example: Chiropractor, Nurse, Physician, Physical Therapist, etc.