Ergonomic Order Form Pitzer College Ergonomic Order Form After an Ergonomic Evaluation, Pitzer HR will send you a list of approved items. Please use the following to choose your preference. Name* First Last Office Location* I have been approved for:* (Please check all that apply) *Please note that delivery of some items can take up to three weeks. An audio or video device (more options below) An ergonomic keyboard An ergonomic mouse (more options below) A keyboard wrist-rest (more options below) A mouse wrist-rest (more options below) Footrest Monitor Riser Anti-fatigue mat Audio/Video devices* Dictation software Portable microphone Ergonomic Keyboard*Please choose style...1) Microsoft Ergonomic Keyboard1)Mouse*Please choose mouse type...1) Trackball, center-orientation2) Trackball, thumb-orientation3) Vertical mouse1)2)3)Keyboard wrist rest*Please choose mouse wrist rest style1) Bead-filled2) Gel-filled3) iMac Keyboard Rest1)2)3)Mouse wrist rest*Please choose mouse wrist rest style1) Bead-filled2) Gel-filled1)2)FootrestPlease choose a footrest type...1) Standard Footrest2) Taller Footrest1)2)Monitor Riser*Please choose style...1) Adjustable Monitor RiserHow many?* One (1) Two (2) 1)Anti-Fatigue Mat*Please choose size...1) 2' x 3'1)Shopping Cart:
