Ergonomic Keyboard or Mouse Request

Ergonomic Keyboard or Mouse Request — Form Fields

This hr template includes 8 fields. Request an ergonomic keyboard, mouse, or wrist support to address discomfort or prevent injury. Free to customize and use on ZenBuild.

• Employee Name (text, required)
• Work Email (email, required)
• Department (text, required)
• Work Location (text, required)
• Equipment Requested (checkboxes, required) — options: Ergonomic Keyboard, Ergonomic Mouse, Wrist Rest, Trackball Mouse, Vertical Mouse
• Health or Medical Need? (multiple choice, required) — options: Yes, No
• Describe the Discomfort or Issue (long text, required)
• Medical Note (if available) (file upload, optional)