Get Ca Work Status Report 2012-2026

The CA Work Status Report is a crucial document that provides information about an employee's ability to work following a medical examination. This guide offers a detailed, step-by-step approach to assist users in accurately completing the form online.

Follow the steps to successfully complete the CA Work Status Report.

1. Press the ‘Get Form’ button to access the CA Work Status Report and open it in your preferred editor.
2. Begin by entering the name of the employee in the designated field. Ensure that the name matches the employee’s official documentation.
3. Next, fill in the department name and number. This detail is important for record-keeping and ensuring the report is correctly filed.
4. Indicate whether the employee is classified as 'industrial' or 'non-industrial' by checking the appropriate box.
5. Complete the job title field to identify the employee's position within the company.
6. Enter the claim number and date of injury (DOI) if applicable, as this information links to any workers' compensation claims.
7. Document the examination dates for the current medical problem in the provided fields.
8. Indicate whether the employee is unable to work full duty by checking the corresponding box and specify the duration of this status.
9. Answer whether the employee is able to work by checking the appropriate box. Complete items #4 and #5 if the employee is released to modified or full duty.
10. Provide a diagnosis or general nature of the illness/injury in the dedicated field, ensuring patient permission is obtained.
11. List specific medical restrictions under section #4, detailing any limitations related to vehicle use, body positions, lifting, and other physical activities.
12. Fill in the estimated return to full duty date; this is necessary when returning an employee to modified work.
13. Indicate whether the restrictions are permanent by checking 'Yes' or 'No.'
14. Specify if the patient is engaged in treatment that requires time off or is taking medication that affects their work situation.
15. Complete the section for time in and time out to document the appointment timing.
16. The treating physician or clinician should sign and date the report, printing their name beneath their signature.
17. Lastly, save your changes to the document. You can download, print, or share the completed form as necessary.

Complete the CA Work Status Report online today to ensure timely and accurate processing.