Free Workplace Ergonomics Feedback Form

Please take a few moments to complete this form. Your insights will help us identify areas of improvement and enhance the overall ergonomic experience for you and your colleagues.
Employee Information | |
Name | [Name] |
Job Title | |
Department | |
Email Address | |
Phone Number | |
Ergonomics Feedback | |||||
Aspect of Ergonomics | Very Satisfied (5) | Satisfied (4) | Neutral (3) | Dissatisfied (2) | Very Dissatisfied (1) |
Chair and Seating | |||||
Desk and Workspace | |||||
Monitor and Display | |||||
Keyboard and Mouse | |||||
Lighting | |||||
Noise Level | |||||
Breaks and Posture | |||||
Workspace Layout | |||||
Comments/Suggestions | |
1 | The workplace chair provides excellent lumbar support. |
2 | |
3 | |
Thank you for taking the time to provide feedback. Your input is valuable in helping us enhance workplace ergonomics.
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