Get Work Status Report

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.

1. Click ‘Get Form’ button to access the report and open it in your preferred digital editor.
2. Begin by entering the employee's name in the designated section. Ensure accuracy as this identifies the individual associated with the report.
3. Input the date of injury (DOI) in the provided field. This is vital for tracking the context of the report.
4. In the physician’s section, fill in the name of the physician conducting the assessment. This information is required for validation.
5. Document the diagnosis accurately, following any relevant medical terminology as instructed.
6. Complete the physician’s address and phone number to facilitate further communication if necessary.
7. Indicate the treatment type for today by selecting either 'Initial Exam,' 'Follow-up,' or 'Other.'
8. 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.'
9. Specify the work status by selecting 'Return to Full Duty,' 'Return to Modified Duty,' or noting inability to work until further notice if applicable.
10. Outline any work restrictions, marking their frequency for each activity such as standing, walking, or lifting.
11. Note the lifting/carrying/pushing/pulling abilities and frequency concerning assigned weight classes.
12. Provide any other comments that may help clarify the situation or additional restrictions.
13. Enter the date of the next appointment to ensure follow-up care is documented.
14. The physician must sign to finalize the report and bring it to completion.
15. 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!