Get Dwc Ad 10133 3 2020-2026
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How to fill out the Dwc Ad 10133 3 online
The Dwc Ad 10133 3 form is essential for describing an employee's job duties and is used to assess their ability to return to work. This guide will provide clear instructions to help you easily fill out this form online, ensuring that both employers and employees can accurately communicate job responsibilities.
Follow the steps to fill out the Dwc Ad 10133 3 form online.
- Click ‘Get Form’ button to access the form and open it in your document editor.
- Begin filling out the form by entering the employee's name, including their last name, first name, and middle initial.
- Next, provide the employer's name and the claim number related to the worker's compensation case.
- Indicate the job address where the employee works and specify the job title.
- Fill in the hours the employee typically works per day and per week.
- In the section labeled ‘Description of job responsibilities’, provide a detailed account of all job duties performed by the employee.
- Select one option from Regular Duty, Modified Duty, or Alternative Work to describe the nature of the employee's duties.
- Check the frequency of activities required for the job. Detailed options include never, occasionally, frequently, and constantly for various tasks such as sitting, walking, and using hands.
- Indicate the daily lifting and carrying requirements of the job, detailing both the height from which items are lifted and the distance they need to be carried.
- Answer whether the job requires specific activities such as driving or working at heights. Provide brief descriptions where appropriate.
- Add comments from both the employee and employer in their respective sections.
- Finally, include the employer contact name and title, have the employer representative sign the form, and date it.
- Once all fields are filled, you can save changes, download, print, or share the completed form as needed.
Complete the Dwc Ad 10133 3 form online to ensure accurate documentation of employee job duties.
A Supplement Job Displacement Benefits (SJDB) voucher can be valued up to $6,000 for eligible workers. This voucher assists with job retraining, education, and other employment-related costs after a workplace injury. Depending on your specific case and the guidelines of Dwc Ad 10133 3, you might qualify for this benefit to help you regain your footing in the job market. Understanding your rights regarding SJDB vouchers is crucial for maximizing your recovery.
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