Light duty 2026

1. Click ‘Get Form’ to open the Light Duty Assignment Request Form in the editor.
2. Begin by entering your Name and Job Title in the designated fields. This information is essential for identifying your request.
3. Fill in the Date of Injury, which helps document the context of your light duty request.
4. Indicate whether you are currently on Worker’s Compensation by selecting 'Yes' or 'No'.
5. Choose whether a light duty assignment is available within your department by selecting the appropriate option.
6. Briefly describe the duties you will be performing during your light duty assignment in the provided space.
7. Specify the Start Date and Time for your light duty assignment, followed by the End Date and Time.
8. Sign and date the form at the Employee Signature section to confirm your request.
9. Ensure that your Supervisor signs and dates their approval, followed by Human Resources' approval if necessary.

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