Get Repetitive Motion Questionnaire Page 1 - Workforce Safety & Insurance

Filling out the Repetitive Motion Questionnaire is an essential step for individuals seeking to address workplace injuries related to repetitive motions. This guide provides a step-by-step approach to complete the first page of the questionnaire efficiently and accurately.

Follow the steps to complete your questionnaire successfully.

1. Press the ‘Get Form’ button to obtain the Repetitive Motion Questionnaire and open it in your preferred document editor.
2. Begin by providing your name in the 'Injured Worker’s Name' field and your claim number in the designated area.
3. Document the body part affected in the 'Body Part' section. Be clear and specific.
4. Enter the mailing date next to the appropriate label to ensure timely return of the questionnaire.
5. Follow the directions outlined at the top of the form, ensuring to read and respond to each question thoroughly.
6. In section 'a', describe the motions of your shoulder(s), arm(s), wrist(s), hand(s), and elbow(s) required by your current job. Be detailed in your response.
7. For question 'b', specify the amount of time spent daily or weekly performing these movements for a clear understanding of your work pattern.
8. Complete question 'c' by indicating how long you have been employed with your current employer.
9. If you have been employed for less than one year, list any previous employers along with the duration and a brief description of your job duties during that time.
10. Continue through the following questions, addressing any inquiries regarding previous injuries, current job duties, hobbies, and other relevant activities.
11. Upon completing all sections, review your responses for accuracy, then sign and date the last page of the form. Lastly, return the questionnaire to Workforce Safety & Insurance at the provided address within the specified timeframe.

Take the next step in managing your workplace injury by completing your Repetitive Motion Questionnaire online today.