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Form-0034 - Early & Safe Return to Work Program -. Employer's report of injury or occupational disease-2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the date at the top of the form. This is essential for record-keeping.
- Fill in the employee's name and address accurately to ensure proper identification.
- Provide a contact number for any follow-up questions regarding the report.
- Indicate whether the employee can return to regular work duties or modified duties by checking the appropriate box and filling in the relevant dates.
- Detail any limitations that apply during this period in the designated section, ensuring clarity for all parties involved.
- Finally, have the physician sign and date the form to validate it before submission.
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