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Get North Carolina State University Ergonomic Evaluation Form 2008-2024

__________________________________ Bldg/Room: __________________________ Occupation: ______________________ Supervisor: ______________________ Analyst Name: ________________ Employee [ ] Contractor [ ] Canceled Appointments [ ] N/A [ ] 1 [ ] 2 More than one Kb/Mouse [ ] Y [ ] N Task Description / Software: _______________________________________________________________________ Computer Use: [ ] <½ Hr. Intervals throughout day, [ ] 1-2 Hr. Intervals throughout day, Other: _________________ Cu.

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