Get Work Status Report - Alameda County Government - Co Alameda Ca

Completing the Work Status Report for Alameda County is a crucial step in documenting an employee's medical status and work capabilities. This guide will provide you with comprehensive steps to accurately fill out the form online, ensuring all necessary information is captured.

Follow the steps to complete the Work Status Report online.

1. Click the ‘Get Form’ button to obtain the Work Status Report template and open it for editing.
2. Begin by entering the name of the employee in the designated field at the top of the form.
3. Next, input the department name and number, and identify whether the case is industrial or non-industrial by selecting the appropriate checkbox.
4. Fill in the job title of the employee and the claim number along with the date of injury (DOI).
5. Document the examination dates during which the employee was assessed for their medical issue.
6. Indicate the employee's work status with respect to their ability to perform duties. If applicable, check the boxes to specify if they are released for modified or full duty.
7. Provide a description of the diagnosis or general nature of the illness or injury, ensuring this is done with patient permission.
8. Outline any specific medical restrictions related to the employee's duties using the detailed options provided for various activities such as lifting, climbing, and environmental exposure.
9. Estimate the return date to full duty and check whether the restrictions are permanent.
10. State if the employee is involved in treatment requiring time off or medication that could affect their work.
11. Complete the time in and time out fields, and ensure the healthcare provider's signature, printed name, date of appointment, next appointment details, and contact information are included.
12. Finally, save the changes to your document, and once completed, you can choose to download, print, or share the Work Status Report.

Complete your Work Status Report online today for a seamless documentation process.