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WellPoint Workstation Evaluation Form
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Document Date: 2011-07-08 15:42:43

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File Size: 991,47 KB

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tray/pad Wireless mouse Pull-out keyboard tray Document holder Flat Screen Monitor Glare / headset Wireless headset Personal / /

Person

Ergonomic / Job Activities / /

Position

Manager PERSON COMPLETING THE EVALUATION EVALUATION DATE Reason / task chair / HR Manager / Form Location address General information Employee Job Title Department Employee / Chair / Special order ergo chair / /

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