Get Ca Dwc Ad 10133.36 2013-2025

The CA DWC AD 10133.36 form is essential for reporting a person's return to work status following a workplace injury. This guide aims to provide clear, step-by-step instructions on how to complete this form effectively online.

Follow the steps to complete the CA DWC AD 10133.36 form online.

1. Click ‘Get Form’ button to access the CA DWC AD 10133.36 form online and open it in the editor.
2. Begin by entering the employee's last name and first name in the designated fields.
3. Fill in the claims administrator's name and contact details, including the claims representative's name.
4. Provide the employer's name, street address, city, state, and zip code.
5. Enter the date of injury and the claim number in the appropriate sections.
6. Indicate the employee's ability to return to work by checking the applicable box: regular work, work with restrictions, or unable to work.
7. For work with restrictions, specify the number of hours the employee can perform various activities such as standing, walking, sitting, bending, squatting, climbing, twisting, reaching, crawling, and driving.
8. Detail any lifting or carrying restrictions by noting the maximum weight and hours per day.
9. If a job description has been provided, record the job title and assess whether the work duties match the activity restrictions.
10. Enter the physician’s name, role (PTP, QME, AME), signature, and the date.
11. Review all entered information for accuracy. Once completed, save changes, and choose the option to download, print, or share the form as needed.

Complete your CA DWC AD 10133.36 form online today for a smooth submission process.