Get Division Of Workers' Compensation Work Status Report - Utsa

Filling out the Division Of Workers' Compensation Work Status Report - Utsa is an essential step for injured employees to report their work status accurately. This guide provides clear, detailed instructions to ensure you complete the form correctly and effectively.

Follow the steps to fill out the Work Status Report accurately.

1. Press the ‘Get Form’ button to access the document and open it in your preferred editing tool.
2. In Part I, enter the injured employee's name, date of injury, social security number, and a brief description of the injury or accident. This section sets the foundation for the report.
3. Provide the doctor’s name, degree, clinic or facility name, contact information, and address in the specified fields to establish the medical source.
4. Indicate the employer's name and provide the insurance carrier's details. This ensures the right parties are informed of the work status.
5. In Part II, determine and mark the employee’s current medical status by selecting whether they can return to work without restrictions, with restrictions, or if they are unable to return to work. Ensure to fill in any required dates for return and restrictions.
6. If the employee is returning to work with restrictions, navigate to Part III to specify the activity restrictions. Mark any relevant limitations concerning posture, motion, and lifting/carrying.
7. In Part IV, document the work injury diagnosis and any expected follow-up appointments. This includes dates and times for evaluations or consultations concerning the injured employee's recovery.
8. Once all sections have been thoughtfully completed, review the details for accuracy, and ensure all necessary fields are filled before finalizing your submission.
9. Finally, save your changes, and choose to download, print, or share the completed Work Status Report as needed.

Complete your Work Status Report online to ensure a smooth process for your recovery and return to work.