Get Work-ability/return To Work (please Complete Form Fully) - Shopaitribes

Filling out the WORK-ABILITY/RETURN TO WORK form is an essential step for individuals returning to work after an injury or illness. This guide provides a clear, step-by-step approach to ensure you complete the form accurately and thoroughly.

Follow the steps to effectively complete your form online.

1. Press the ‘Get Form’ button to access the WORK-ABILITY/RETURN TO WORK form and open it in your preferred online editor.
2. Begin with the employee information section. Fill in your name, department, job title, and the date of your injury or illness.
3. In the diagnosis section, provide details about your condition and include the appropriate ICD code. This is important for medical documentation.
4. Answer the question regarding whether your condition has resulted in a permanent partial disability. Select either ‘Yes’ or ‘No’.
5. Specify whether the injury or illness is work-related by choosing ‘Yes’ or ‘No’. Indicate any pre-existing conditions that may affect your current injury.
6. Indicate whether maximum medical improvement has been reached by selecting ‘Yes’ or ‘No’. If limitations exist, specify them clearly.
7. If applicable, state the dates the user was unable to work due to the injury or illness, including start and end dates.
8. Detail any accommodations needed for the individual to return to a home environment, answering ‘Yes’ or ‘No’.
9. Describe the body parts affected by the injury. Select from the options provided or specify additional details.
10. Complete the sections regarding physical demands, including weight limits for lifting and carrying, and the frequency of specific activities.
11. Comment on any specific restrictions, such as pushing, pulling, or gripping. Describe how these restrictions will impact the individual’s ability to perform their job.
12. Provide your prognosis, including whether full recovery is expected and any anticipated time frames.
13. Ensure that all sections of the form are carefully reviewed and filled out fully. Once complete, use the options to save changes, download, print, or share the form as necessary.

Get started on completing your WORK-ABILITY/RETURN TO WORK form online today!