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Click ‘Get Form’ to open it in the editor.
Begin by reviewing the 'Work Activities' section. Indicate if you have lost enjoyment in your job due to injuries from the accident by checking the appropriate box.
Select your employment status at the time of the accident and specify your work capacity since then, choosing from options like 'Resumed My Same Job and Duties' or 'I Have Not Resumed Work'.
Proceed to the 'Domestic Activities' section. Check any activities you can no longer enjoy, such as laundry or cleaning, and provide details where necessary.
Continue through sections on 'Household Activities', 'Studies/Educational Activities', and 'Hobby Activities', filling out each part thoroughly based on your experiences post-accident.
Finally, complete the sections for sports and traveling activities, detailing how your injuries have affected these areas of your life.
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