Get Work Status Report
How it works
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Open form follow the instructions
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Easily sign the form with your finger
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Send filled & signed form or save
How to fill out the Work Status Report online
The Work Status Report is an essential document used to convey an employee's work capabilities following a medical evaluation. This guide provides clear instructions on how to effectively fill out the report online, ensuring accurate and helpful submissions.
Follow the steps to complete the Work Status Report online.
- Click ‘Get Form’ button to access the report and open it in your preferred digital editor.
- Begin by entering the employee's name in the designated section. Ensure accuracy as this identifies the individual associated with the report.
- Input the date of injury (DOI) in the provided field. This is vital for tracking the context of the report.
- In the physician’s section, fill in the name of the physician conducting the assessment. This information is required for validation.
- Document the diagnosis accurately, following any relevant medical terminology as instructed.
- Complete the physician’s address and phone number to facilitate further communication if necessary.
- Indicate the treatment type for today by selecting either 'Initial Exam,' 'Follow-up,' or 'Other.'
- Describe the patient’s condition by checking the appropriate status: 'Resolved,' 'Improving,' 'Not Improving,' 'Not Work Related,' 'Permanent & Stationary,' or 'No Impairment/No Permanent Disability.'
- Specify the work status by selecting 'Return to Full Duty,' 'Return to Modified Duty,' or noting inability to work until further notice if applicable.
- Outline any work restrictions, marking their frequency for each activity such as standing, walking, or lifting.
- Note the lifting/carrying/pushing/pulling abilities and frequency concerning assigned weight classes.
- Provide any other comments that may help clarify the situation or additional restrictions.
- Enter the date of the next appointment to ensure follow-up care is documented.
- The physician must sign to finalize the report and bring it to completion.
- Once all sections are completed, save changes or share the form electronically. Users also have the option to download or print it for submission.
Complete your Work Status Report online now to ensure a smooth process for your work recovery!
Benefits are not paid for the first week unless your injury caused you to lose all or some of your pay (disability) for 14 days or more. In workers' compensation, disability does not mean a physical handicap.
Fill Work Status Report
This form is provided for the purpose of obtaining a duty status report for the employee named below. Employee - You are required to report your injury to your employer within 30 days if your employer has workers' compensation insurance. Submit forms online through the Employees' Compensation Operations and Management Portal (ECOMP). On the ECOMP site you can register for an account. Tell the representative you want to submit a work report. Please complete this form after every medical visit.
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