Workplace Ergonomic Evaluation

How do you know if your work environment is putting employees at risk of a musculoskeletal injury? or if workers daily tasks are hazardous to their body if done incorrectly? RPM: Trucking Industry Safety can help!

Using state-of-the-art AI, RPM will come to your workplace to monitor employee posture or body movement with a mobile application. After recordings have been captured RPM will send you a complete report of the findings and can assist you with a list of recommendations for you to implement at your workplace.

If you are interested in getting an ergonomics evaluation done at your workplace, please complete the form below and an RPM safety program representative will be in touch.

Ergonomics Evaluation

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Contact Information

Your Name(Required)

First Last

Company Name(Required)

Your Address(Required)

Street Address Address Line 2 City Postal Code

How Can We Reach You?

Preferred Method of Contact

Email Address(Required)

Phone Number(Required)

Details

Which areas of the company would you like evaluated?(Required)

Maintenance Shop

Wash Bay

Office Area

Yard

Warehouse

Is there a different area that wasn't listed above that you would like evaluated?

What date would work best for you? (if there is a conflict in date we will contact you to reschedule)(Required)

What time work work best for you? (if there is a conflict with the time we will contact you to reschedule)(Required)

Is there anything else you would like us to know?

Consent(Required)

I agree to the following RPM Ergonomics Evaluation policy:

You hereby acknowledge that RPM Trucking Industry will delete the videos recorded after 30 days of the ergonomics evaluation report has been sent to the organization.

You hereby give RPM Trucking Safety Industry the right and permission to copyright and/or publish, reproduce or otherwise use all the contents in the videos produced, written materials, and audio-visual recordings. You acknowledge and understand these materials are used for both commercial and/or non-commercial purposes.

You hereby acknowledge that RPM Trucking Safety Industry will contact your organization to receive permission to use any records or reports before posting them on social media and for marketing purposes. If RPM Trucking Safety Industry is to use your recordings, they will redact all information pertaining to your organization to keep it anonymous and they will send your organization proofs before finalizing.

Your organization understands that the image may be edited, copied, exhibited, published and/or distributed. You also understand this material may be used individually or in conjunction with other media in any medium, including without limitation to print publications, digital publications, and/or public broadcast for any lawful purpose. There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.

You understand your organization’s participation is voluntary and that you may, at any time, discontinue your involvement before signing this document. If you choose to discontinue participation, you will notify the principal party RPM Trucking Safety Industry by providing written notice.

You hereby certify that anyone recorded at your organization is over eighteen years of age.

By signing this form via the online bookings form, your organization acknowledges that they have completely read and fully understand the above consent and release and agree to be bound thereby. You hereby release any and all claims against any person or organization utilizing this material for marketing, educational, promotional, and/or any other lawful purpose whatsoever.

Date signed(Required)