Get Form-0034 - Early & Safe Return To Work Program -. Employer's Report Of Injury Or Occupational Disease 2020-2025

Completing the Form-0034 accurately is essential for facilitating a smooth return to work for individuals recovering from injuries or occupational diseases. This guide provides a clear, step-by-step process to assist you in filling out the form online.

Follow the steps to complete the online form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the date in the designated section at the top of the form. Ensure that you enter the exact date the report is being completed.
3. Enter the employee's name clearly. This should correspond to the individual who is returning to work.
4. Provide the employee's address in the appropriate field. Including both street address and city is crucial for contact purposes.
5. Fill in the employee's contact number. Ensure that it is a current number where they can be reached easily.
6. In the section titled 'To Whom It May Concern', there will be options regarding the employee's return to work. Select either 'Regular work duties' or 'Modified work duties' as applicable.
7. If the employee is returning to modified work duties, specify the dates of the modified duties clearly in the provided fields.
8. Detail any limitations the employee may have during their return to work in the section labeled 'Limitations'. Be thorough and ensure clarity to avoid misunderstandings.
9. The form requires the physician's name and signature at the bottom. Ensure this is completed by the appropriate healthcare professional.
10. Finalize the form by saving all changes made. Users can then download, print, or share the completed form as necessary.

Ready to proceed? Complete your forms online today for a seamless return to work process.