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Work restrictions 2026
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- Click ‘Get Form’ to open the work restrictions document in the editor.
- Begin by entering your Employee Name, Location, and Employee Number in the designated fields.
- Indicate whether you have restrictions by selecting 'Yes' or 'No'. If 'Yes', proceed to fill out the Posture/Movement section, specifying estimated durations for sitting, standing, and walking.
- In the Strength section, use letters (N, O, F, C) to indicate frequency for various lifting and movement tasks. Fill in the corresponding weight categories as applicable.
- Complete the Mental and Psychological Demands section by checking 'Yes' or 'No' for each task requirement based on your capabilities.
- Fill out Environmental Conditions by indicating exposure levels and any necessary personal protective equipment.
- Provide sensory information regarding vision and auditory capabilities before finalizing with additional notes and healthcare provider details.
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work restrictions form pdf
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Overtime work must be approved by a supervisor before it is performed. Working overtime (more than 40 hours in a work week) without prior supervisorRead more