Free Workplace Ergonomic Equipment Slip

Employee Information
Employee Name: | [Your Name] |
Employee ID: | |
Department: | |
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.
Item | Quantity | Additional Details |
Ergonomic Chair | [1] | Lumbar support and adjustable armrests |
Provide a brief explanation of why the requested ergonomics equipment is necessary for your work
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:
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