Ergonomic assessment

Request an ergonomic assessment

Complete the following form to request an ergonomic assessment of your workstation.

Ergonomic assessments will be scheduled shortly after your request is submitted.

Have you reviewed Safe Work Manitoba Ergonomics: Adjusting the Office Workstation (PDF)?

Please review Safe Work Manitoba Ergonomics: Adjusting the Office Workstation (PDF) prior to your ergonomic assessment and make any necessary changes to your workstation based on the information provided in the resource.
I acknowledge that I have reviewed Safe Work Manitoba - Ergonomics: Adjusting the Office Workstation and made changes to my workstation based on the information provided in the resource.

Employee contact information

Supervisor's contact information

Ergonomic Assessment Request (Please select all that apply)

Chair Fit and Function
Desk Fit and Function
Keyboard, Mouse, and Input Devices
Monitor and Screen Position
Environmental Factors
Has the employee completed the Ergonomic training – Office Ergonomics course within UM Learn??

Ergonomic training- Office Ergonomics course must be completed within UM Learn before an Ergonomic assessment will be scheduled. 

To access the training, self-enroll in the course called “Ergonomic training – Office Ergonomics” on UM Learn. 

Assessment location

Which campus are you located on?
Indicate which environment you are requesting an assessment for?

Scheduling Assessment

Please choose the day and times that would typically work best for an assessor to meet with you:

  • Monday AM /  Monday PM
  • Tuesday AM / Tuesday  PM
  • Wednesday AM / Tuesday PM
  • Thursday AM / Thursday  PM
  • Friday  AM / Friday PM
Please note that onsite ergonomic assessments are conducted in person and all home-office or remote office ergonomic assessments are conducted over video call. We will review your request and email you to schedule your assessment.

Priority

Has a health care professional recommended that you have an ergonomic assessment completed on your workstation?

Pictures of your workstation

Please email 3 pictures of you at your workstation to ehso@umanitoba.ca so that we can get a sense of your workstation and equipment. Try to include different angles. Include a photo that shows the full workstation and a photo of you sitting at your workstation with hands on the keyboard.

After you have submitted your request and pictures, we will review your responses within one week and contact you to schedule an assessment. Assessments will be scheduled for either in-person or virtually. After the assessment, a report will be sent to both you and your supervisor.

Notice Regarding Collection, Use, and Disclosure of Personal Information by the University
Your personal information is being collected under the authority of The University of Manitoba Act. The information you provide will be used by the University for the purpose of obtaining your consent to share your personal information with the University departments/units indicated above, and for communication. Your personal information may be disclosed to Enabling Access Inc for the purpose scheduling an assessment. Your personal information will not be used or disclosed for other purposes, unless permitted by The Freedom of Information and Protection of Privacy Act (FIPPA). (6) If you have any questions about the collection of your personal information, contact the Access & Privacy Office (tel. 204-474-9462), 233 Elizabeth Dafoe Library, University of Manitoba, Winnipeg, MB, R3T 2N2.

We ask that you please do not include any personal health information in the form.