Work restriction form 2025

1. Click ‘Get Form’ to open the work restriction form in the editor.
2. Begin by entering the patient’s name, date of injury, and date of appointment in the designated fields at the top of the form.
3. Fill in the employer's details including name, job title, and contact information to ensure proper communication.
4. Select the appropriate medical recommendation by checking one of the options provided regarding restrictions or off-work status.
5. In the 'Restrictions' section, indicate any specific limitations such as use of hands or exposure to certain conditions by checking relevant boxes.
6. Complete the 'Capabilities' section by marking how many hours per day the individual can work and their ability to perform various activities.
7. Finally, ensure that all sections are filled out accurately before saving or sharing your completed form for review.

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