Get Functional Capacity Checklist

Filling out the Functional Capacity Checklist is an important step in assessing an individual's ability to perform daily activities and succeed in a work environment. This guide provides clear, step-by-step instructions on how to efficiently complete the checklist online.

Follow the steps to accurately complete your checklist.

1. Press the ‘Get Form’ button to access the checklist and open it in your chosen editor.
2. Begin with the 'Self Care' section. Assess whether the individual requires personal assistance for basic activities. Answer questions regarding their living situation and need for care modifications.
3. Next, move to the 'Communication' section. Evaluate the individual's ability to communicate effectively and note if they rely on assistive devices for this purpose.
4. Proceed to the 'Mobility' section. Determine the extent to which the individual can move independently, and whether they need assistance or adaptations to navigate their environment.
5. Then, fill out the 'Self-Direction' section. Consider if the individual requires help to initiate tasks or make decisions, and if they have a guardian for support.
6. In the 'Work Tolerance' section, assess if the individual faces limitations in capacity or endurance that might affect their ability to work regularly. Note any needs for breaks or modified schedules.
7. Next, review the 'Work Skills' section. Determine if the individual's disability affects their ability to acquire or maintain job skills or if they require accommodations at work.
8. Finally, complete the 'Interpersonal Skills' section. Reflect on the individual's ability to establish relationships at work and their capacity to accept directions.
9. Once all sections are filled out, review your answers for accuracy. After confirming all information is correct, you can save changes, download, print, or share the checklist as needed.

Complete your Functional Capacity Checklist online today to facilitate your assessment process.