Get Ca-17.pdf

The Ca-17 form, also known as the Duty Status Report, is essential for documenting an employee's work capabilities following an injury. This guide provides clear, step-by-step instructions on filling out the form online to ensure accuracy and compliance with requirements.

Follow the steps to complete the Ca-17 form online.

1. Click the ‘Get Form’ button to access the Ca-17 form and open it for editing.
2. Begin filling out Side A of the form, starting with the employee's name (last, first, middle) and the date of injury. If known, include the OWCP file number in the designated area.
3. Provide the employee's social security number and occupation in the respective fields on Side A.
4. Describe how the injury occurred and specify the parts of the body affected in the provided section on Side A.
5. Indicate the hours the employee typically works per day and days per week in the designated areas.
6. Specify the usual work requirements and check whether the employee performs these tasks continuously or intermittently. Include the number of hours and maximum weight lifted per day.
7. Proceed to Side B of the form for the physician to complete. They will assess whether the history of injury given corresponds with the employee's account, describe clinical findings, and provide a diagnosis.
8. The physician should sign and date the form, ensuring all relevant sections regarding the employee's ability to return to work are addressed.
9. Once all sections are complete, save any changes made to the form. Users can then download, print, or share the completed Ca-17 form as necessary.

Complete your forms online today for a streamlined experience.