Local 79 health professionals report of worker's function form 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin with Section A, where the worker or employer must fill in personal information such as the WSIB Claim Number, Employee Number, and contact details. Ensure all fields are accurately completed.
  3. Next, indicate the Date of Injury/Onset of Illness and provide details about the job at the time of injury, including Division and Work Address.
  4. In Section B, health professionals will select whether this is an Initial or Follow-Up Form. They should then provide detailed information regarding the nature of the injury or illness and expected recovery time.
  5. Check the appropriate box under 'Ability to Work' based on the worker's current condition. Specify any functional limitations by checking relevant strength demands and abilities.
  6. Complete any additional sections regarding behavioral/cognitive restrictions if applicable, ensuring all comments and specific limitations are noted.
  7. Finally, health professionals should print their information in Section C and sign where indicated. The worker must also provide consent by signing and dating the form.

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Employers who have forms specifically tailored to their workers and work environment may use their forms. Please note that, in this case, the employer must pay the health professional directly for completing the form. Health professionals who complete the WSIBs FAF are paid a fee of $40.
[to be completed only by a physician or nurse practitioner] When your completed form arrives at the WSIB, we will scan it into the appropriate WSIB claim record and then send it for payment processing.
This form, when completed, is used to enable an employer to accommodate an ill or injured employee to remain at, or if absence is unavoidable, to return to work as soon as they are safely able to do so.

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