Physician's Assessment of Work Abilities Form - Kwantlen 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the employee's name and the date at the top of the form. This information is crucial for identification.
  3. In the 'Work Abilities' section, assess each ability listed. For each ability, mark either 'Fully Able' or 'Restricted' based on your evaluation.
  4. If any restrictions are noted, specify the number of hours and work shifts that may be suitable for the employee.
  5. Complete the section regarding the nature of illness without providing a diagnosis. Indicate if the employee can return to work immediately and provide details on any necessary rehabilitation or treatment.
  6. Finally, sign and print your name along with the date at the bottom of the form to validate your assessment.

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