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- NC DENR Work Ability Evaluation Form 2002
Get NC DENR Work Ability Evaluation Form 2002-2024
The frequency and number of hours a day the employee is able to do the following specified types of activities. Activity Frequency Continuous Intermittent 0 1 Number of Hours per Day 3 4 5 2 6 7 8 Sitting Walking Lifting Bending Squatting Climbing Kneeling Twisting Standing RESTRICTIONS-Circle all that apply 5. Employee can lift: 6. Hand restrictions? Simple grasping? NONE 0-10 lbs. No Yes Yes No 10-20 lbs 20-50 lbs. (If yes, type) Pushing and pulling? 7. Can the employee reach.
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