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Ergonomic Order Form

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Ergonomic Order Form

Ergonomic Order FormJoe Dickson2020-09-08T15:33:43-07:00

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*
1)
Mouse*
1)
2)
3)
Keyboard wrist rest*
1)
2)
3)
Mouse wrist rest*
1)
2)
Footrest
1)
2)
Monitor Riser*
How many?*
- One (1)
- Two (2)
1)
Anti-Fatigue Mat*
1)
Shopping Cart:

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