Industrial Ergonomics Program Generator

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Name of organization:

Insurance company:

Who will be in charge of the industrial ergonomics control program?

Task	Area	Excessive Force	Vibration Hazards	Awkward Postures	Contact Stress	Repetitive Motions	Environmental Stressors
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How soon after an employee starts work do you complete workstation evaluation?

How soon after an ergonomics complaint do you complete a workstation evaluation?

Organization's medical provider name:

Medical provider's street address:

City:

State:

ZIP code:

Medical provider phone:

How many years do you retain records related to this program?

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