Dwc ad form 10133 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the employee's name, employer's name, and claim number in the designated fields. Ensure accuracy as this information is crucial for processing.
3. Fill in the job address and title, along with the hours worked per day and week. This provides context for the job duties being described.
4. In the 'Description of Job Responsibilities' section, detail all job duties clearly. This helps assess the employee's ability to return to work.
5. Check whether the employee performs regular, modified, or alternative duties. This categorization is important for understanding their work capacity.
6. For each activity listed, indicate how often it occurs (never, occasionally, frequently, constantly) by selecting the appropriate option.
7. Complete the lifting and carrying requirements by specifying heights and distances as needed. Describe any heaviest items carried for clarity.
8. Answer yes or no to questions regarding job requirements such as driving or exposure to hazardous conditions. Provide brief descriptions if applicable.
9. Finally, ensure both employee and employer signatures are added along with dates before submitting the form.

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