Workplace Ergonomic Equipment Slip
WORKPLACE ERGONOMICS EQUIPMENT SLIP
Employee Information
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Employee Name: |
[Your Name] |
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Employee ID: |
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Department: |
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Date: |
Ergonomics Equipment Request
Please specify the ergonomics equipment required for your workspace. Use the table below to list each item, quantity, and any additional details.
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Item |
Quantity |
Additional Details |
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Ergonomic Chair |
[1] |
Lumbar support and adjustable armrests |
Provide a brief explanation of why the requested ergonomics equipment is necessary for your work
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Employee Confirmation
I, [Your Name], acknowledge that the requested ergonomics equipment is essential for my comfort and productivity.
Date:
Manager Approval
I, [Manager's Name], approve the request for ergonomics equipment for [Your Name].
Date:
