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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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