Duties form 2026

See details

4.8 out of 5

205 votes

The document outlines a form designed to facilitate the identification and implementation of suitable duties for employees with workplace injuries or diseases. It emphasizes the importance of early intervention in rehabilitation, involving collaboration among the employee, their supervisor, case manager, and treating doctor. The form is divided into three parts: pre-injury work description, potential suitable duties, and work capacity assessment. It aims to ensure a safe and effective return to work while maintaining privacy and obtaining necessary consent from the employee.

Here's how it works

01. Edit your duties form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send suitable duties template via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out the duties form with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the duties form in the editor.
Begin with Part 1: Pre-Injury Work Description. Fill in the employee's details, including their job title and pre-injury hours. Discuss with the employee and supervisor to accurately capture inherent job requirements.
In Part 1, assess any personal or workplace factors that may delay return to work (RTW) and document how these can be managed.
Move to Part 2: Potential Suitable Duties. After a workplace assessment, identify modifications needed for pre-injury duties or alternative duties available within the organization.
Document any support offered to the employee, such as training or communication strategies, ensuring all parties agree on actions taken.
Finally, complete Part 3: Work Capacity by consulting with the treating doctor. Record medical opinions regarding recovery prognosis and current work capacity.

Start using our platform today for free to streamline your duties form completion!

See more duties form versions

We've got more versions of the duties form form. Select the right duties form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (205 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

suitable duties

Duties form pdf Printable duties form Duties form online CBP Form 6059B instructions C-105.2 blank form U.S. Customs Declaration Form download NYS Workers Compensation forms C-2 U.S. Customs Declaration form for shipping

Security and compliance

At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.

Learn more