If your doctor indicates that you need an ergonomic evaluation of your work site in order to return to work or to remain at work, please inform your supervisor and then fill out, print and submit the form at this website.

The Industrial Hygienist from Safety and Claims will receive the request and identify who will come out to assess your work station. DAJD management and your supervisor will be notified so that coordination for the evaluation and any modifications can take place.

If you are already on medical leave when the evaluation is requested by your doctor, fax the prescription to DAJD Human Resources to request the evaluation in advance of your return.