Get Ca Dwc Ad 10133.36 2014-2025

This guide provides clear and supportive instructions for filling out the CA DWC AD 10133.36 form online. The purpose of this form is to report work capacities and activity restrictions following an injury, ensuring clear communication with the employer.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin by filling in the employee's last name and first name in the designated fields. Ensure the spellings are accurate for proper identification.
3. Provide the claims administrator's name and contact details, followed by the claims representative's information.
4. Enter the employer's name, street address, city, state (Michigan), and zip code to establish proper communication lines.
5. Indicate the date of injury and the claim number, ensuring the details match other related documentation.
6. Specify whether the employee can return to regular work or if they can work with specific restrictions. Clearly indicate the hours for standing, walking, and sitting restrictions.
7. Detail any lifting or carrying restrictions, including maximum weight limits and duration of these activities throughout the workday.
8. Describe any limitations on activities such as climbing, bending, or keyboarding, ensuring to highlight which hand or side is affected.
9. If provided with a job description, fill in the job title and work location. Then, evaluate if the work capacities and restrictions align with the job's physical requirements.
10. Complete the physician's name and their role, sign the form, and add the date before finalizing.
11. Once all sections are filled, review for accuracy, then save changes, and download or print the completed form as necessary.

Complete your CA DWC AD 10133.36 form online today to ensure timely and accurate reporting.