Get Short-term Disability Form (ona) - City Of Hamilton - Hamilton

Completing the Short-Term Disability Form is an essential step in securing your benefits during a period of medical absence. This guide aims to provide you with clear, step-by-step instructions to assist you in filling out the form accurately and thoroughly online.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to access the Short-Term Disability Form and open it in the editor.
2. Begin with the Employee Statement section. Fill in your name, department, and employee number as required. Ensure that you provide accurate information.
3. Indicate the start date of your absence in the format (day/month/year). Confirm whether your absence is due to a workplace accident or incident by selecting 'Yes' or 'No'.
4. Provide your occupation or title. Next, note the physical effort required for your regular duties by selecting from light, moderate, or heavy.
5. Read and acknowledge the employee authorization statement. Sign and date the form at the designated areas to validate your submission.
6. Proceed to the Attending Physician's Statement section. Ensure your physician completes this part, providing the nature of your illness or injury and the initial occurrence date.
7. The physician should also indicate whether your condition is related to employment and the frequency of their visits during your absence.
8. If applicable, your physician should fill in details regarding hospitalizations, specialist referrals, and your treatment plan.
9. The physician must assess your ability to work and provide relevant medical restrictions, as well as prognoses for recovery and potential return to modified duties.
10. Once all sections are filled, ensure that both you and your physician have signed where needed. Review the completed form for accuracy.
11. Save any changes made to the form. You can then download, print, or share the completed document as needed.

Take the next step towards securing your short-term disability benefits by completing the form online today.