{"id":17980,"date":"2021-08-19T10:26:52","date_gmt":"2021-08-19T14:26:52","guid":{"rendered":"https:\/\/www.bu.edu\/ehs\/?page_id=17980"},"modified":"2021-08-19T11:19:18","modified_gmt":"2021-08-19T15:19:18","slug":"17980-2","status":"publish","type":"page","link":"https:\/\/www.bu.edu\/ehs\/residential-safety-home\/residential-safety-programs-services\/industrial-hygiene\/ergonomics-2\/ergonomics-online-forms\/17980-2\/","title":{"rendered":""},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_143' style='display:none'><div id='gf_143' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Ergonomic Assessment<\/h3>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_143'  action='\/ehs\/wp-json\/wp\/v2\/pages\/17980#gf_143' data-formid='143' >\n        <div id='gf_progressbar_wrapper_143' class='gf_progressbar_wrapper'>\n        \t<h3 class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>2<\/span> - Contact Information\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_red' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_red percentbar_50' style='width:50%;'><span>50%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_143_1' class='gform_page ' data-js='page-field-id-13' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_143' class='gform_fields top_label form_sublabel_below description_above'><li id=\"field_143_2\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_143_2\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_143_2'>\n                            \n                            <span id='input_143_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_143_2_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_143_2_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_143_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.6' id='input_143_2_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_143_2_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_143_3\"  class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_143_3\"><label class='gfield_label gform-field-label' for='input_143_3' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_143_3' type='text' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_143_4\"  class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_143_4\"><label class='gfield_label gform-field-label' for='input_143_4' >Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_143_4' type='text' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_143_1' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_143\").val(\"2\");  jQuery(\"#gform_143\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_143\").val(\"2\");  jQuery(\"#gform_143\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_143_2' class='gform_page' data-js='page-field-id-1' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_143_2' class='gform_fields top_label form_sublabel_below description_above'><li id=\"field_143_5\"  class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_143_5\"><label class='gfield_label gform-field-label' for='input_143_5' >Campus<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_5' id='input_143_5' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Charles River Campus (CRC)' >Charles River Campus (CRC)<\/option><option value='Medical Campus (BUMC)' >Medical Campus (BUMC)<\/option><option value='Boston Medical Center (BMC)' >Boston Medical Center (BMC)<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id=\"field_143_9\"  class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_143_9\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Office Address:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_143_9'>Please provide street address as well as office room #.  <\/div>    \n                    <div class='ginput_complex ginput_container has_street has_street2 ginput_container_address gform-grid-row' id='input_143_9' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_143_9_1_container' >\n                                        <input type='text' name='input_9.1' id='input_143_9_1' value=''    aria-required='true'    \/>\n                                        <label for='input_143_9_1' id='input_143_9_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_143_9_2_container' >\n                                        <input type='text' name='input_9.2' id='input_143_9_2' value=''     aria-required='false'   \/>\n                                        <label for='input_143_9_2' id='input_143_9_2_label' class='gform-field-label gform-field-label--type-sub '>Room #:<\/label>\n                                    <\/span><input type='hidden' class='gform_hidden' name='input_9.4' id='input_143_9_4' value='Massachusetts'\/><input type='hidden' class='gform_hidden' name='input_9.6' id='input_143_9_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_143_7\"  class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_143_7\"><label class='gfield_label gform-field-label' for='input_143_7' >Supervisor Email:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_7' id='input_143_7' type='text' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_143_8\"  class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_143_8\"><label class='gfield_label gform-field-label' for='input_143_8' >Would you like to have your workstation evaluated by Environmental Health &amp; Safety (EHS)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_8' id='input_143_8' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='YES' >YES<\/option><option value='NO' selected='selected'>NO<\/option><\/select><\/div><\/li><li id=\"field_143_11\"  class=\"gfield gfield--type-multiselect gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_143_11\"><label class='gfield_label gform-field-label' for='input_143_11' >Please select days and times that work best for you:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_multiselect'><select multiple='multiple' data-placeholder='Click to select...' size='7' name='input_11[]' id='input_143_11' class='medium gfield_select'   aria-invalid=\"false\" aria-required=\"true\" ><option value='Mon - AM' >Mon - AM<\/option><option value='Mon - PM' >Mon - PM<\/option><option value='Tue - AM' >Tue - AM<\/option><option value='Tue - PM' >Tue - PM<\/option><option value='Wed - AM' >Wed - AM<\/option><option value='Wed - PM' >Wed - PM<\/option><option value='Thu - AM' >Thu - AM<\/option><option value='Thu - PM' >Thu - PM<\/option><option value='Fri - AM' >Fri - AM<\/option><option value='Fri - PM' >Fri - PM<\/option><\/select><\/div><\/li><li id=\"field_143_13\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_143_13\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >At my workstation, I am experiencing the following issues:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_143_13'><li class='gchoice gchoice_143_13_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.1' type='checkbox'  value='Excessive fatigue, eye strain, or neck or back pain.'  id='choice_143_13_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_143_13_1' id='label_143_13_1' class='gform-field-label gform-field-label--type-inline'>Excessive fatigue, eye strain, or neck or back pain.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_143_13_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.2' type='checkbox'  value='Discomfort or awkward positioning with arms, wrists, or shoulders.'  id='choice_143_13_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_143_13_2' id='label_143_13_2' class='gform-field-label gform-field-label--type-inline'>Discomfort or awkward positioning with arms, wrists, or shoulders.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_143_13_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.3' type='checkbox'  value='Awkward head postures or frequent movements of the head and neck to look from the monitor to a document.'  id='choice_143_13_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_143_13_3' id='label_143_13_3' class='gform-field-label gform-field-label--type-inline'>Awkward head postures or frequent movements of the head and neck to look from the monitor to a document.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_143_13_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.4' type='checkbox'  value='Space issues on or under work surfaces.'  id='choice_143_13_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_143_13_4' id='label_143_13_4' class='gform-field-label gform-field-label--type-inline'>Space issues on or under work surfaces.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_143_13_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.5' type='checkbox'  value='Inadequate support or lack of support for back, legs, lumbar, seat, or arms.'  id='choice_143_13_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_143_13_5' id='label_143_13_5' class='gform-field-label gform-field-label--type-inline'>Inadequate support or lack of support for back, legs, lumbar, seat, or arms.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_143_13_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.6' type='checkbox'  value='No issues.  I would like to learn more about an ergonomic setup.'  id='choice_143_13_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_143_13_6' id='label_143_13_6' class='gform-field-label gform-field-label--type-inline'>No issues.  I would like to learn more about an ergonomic setup.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_143_14\"  class=\"gfield gfield--type-section gsection bu_google_recaptcha_section field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_143_14\"><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_143_15\"  class=\"gfield gfield--type-html bu_google_recaptcha gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_143_15\"><div class=\"g-recaptcha\" data-sitekey=\"6LeGxkEjAAAAAK4nzHZn3a_6jB2ELSN935WrVBfC\"><\/div><\/li><\/ul><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_143' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='if(window[\"gf_submitting_143\"]){return false;}  window[\"gf_submitting_143\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_143\"]){return false;} window[\"gf_submitting_143\"]=true;  jQuery(\"#gform_143\").trigger(\"submit\",[true]); }' \/> <input type='submit' id='gform_submit_button_143' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_143\"]){return false;}  window[\"gf_submitting_143\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_143\"]){return false;} window[\"gf_submitting_143\"]=true;  jQuery(\"#gform_143\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_143' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='143' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_143' value='WyJbXSIsImQ5Y2U2OGUxNzE1OTZlYjZkN2E4MzI4YmJhNDVlODY3Il0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_143' id='gform_target_page_number_143' value='2' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_143' id='gform_source_page_number_143' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/div><\/div>\n                        <\/form>\n                        <\/div><script type=\"text\/javascript\">\ngform.initializeOnLoaded( function() {gformInitSpinner( 143, 'https:\/\/www.bu.edu\/ehs\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_143').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_143');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_143').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_143').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_143').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_143').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_143').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_143').val();gformInitSpinner( 143, 'https:\/\/www.bu.edu\/ehs\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [143, current_page]);window['gf_submitting_143'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_143').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_143').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [143]);window['gf_submitting_143'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_143').text());}, 50);}else{jQuery('#gform_143').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [143, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 143, currentPage: current_page } });} );} );\n<\/script>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":3090,"featured_media":0,"parent":17531,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/www.bu.edu\/ehs\/wp-json\/wp\/v2\/pages\/17980"}],"collection":[{"href":"https:\/\/www.bu.edu\/ehs\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.bu.edu\/ehs\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/ehs\/wp-json\/wp\/v2\/users\/3090"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/ehs\/wp-json\/wp\/v2\/comments?post=17980"}],"version-history":[{"count":1,"href":"https:\/\/www.bu.edu\/ehs\/wp-json\/wp\/v2\/pages\/17980\/revisions"}],"predecessor-version":[{"id":17981,"href":"https:\/\/www.bu.edu\/ehs\/wp-json\/wp\/v2\/pages\/17980\/revisions\/17981"}],"up":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/ehs\/wp-json\/wp\/v2\/pages\/17531"}],"wp:attachment":[{"href":"https:\/\/www.bu.edu\/ehs\/wp-json\/wp\/v2\/media?parent=17980"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}