TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
DEPARTMENT OF SAFETY SERVICES
OCCUPATIONAL SAFETY
ERGONOMIC CONSULTATION REQUEST
Please fill out the following form to request an ergonomic evaluation. All fields are required. Once the form has been submitted, it will be reviewed by Safety Services and the consultation will be scheduled. For additional information, contact your campus safety services office.
  • Amarillo (806)-354-5441
  • El Paso (915)-783-5245
  • Odessa (432)-335-1820
  • Lubbock (806)-743-2597
Request Date: 5/18/2013
Requestor Name: enter your name
Room Number: enter office/location to be evaluated
Phone Number: enter your phone number
E-mail Address: enter your e-mail address
Department: enter your department name
Campus: select your campus
- Enter the reason for consultation