Workability form 2026

1. Click ‘Get Form’ to open the workability evaluation form in the editor.
2. Begin by entering the injured employee's name in the designated field, followed by the date of injury.
3. In the 'Present Job and Description' section, provide a brief overview of the employee's current role.
4. For each activity listed (e.g., sitting, walking), check the appropriate frequency and indicate how many hours per day the employee can perform these activities.
5. Circle any restrictions that apply to lifting and hand functions. Specify if there are limitations on pushing, pulling, or reaching above shoulder level.
6. Answer questions regarding environmental factors such as heat, cold, and exposure to dust. Provide explanations for any 'Yes' answers.
7. Complete sections regarding limitations in communication and ability to work full-time. Include any necessary remarks or comments at the end of the form.

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