Release return work form print 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the worker's name and claim number at the top of the form. This information is crucial for identifying the case.
3. Indicate whether the worker is medically stationary by selecting 'Yes' or 'No'. If 'Yes', provide the date; if 'No', enter an estimated date for when they will be medically stationary.
4. Next, specify if there are any permanent restrictions. Choose from 'Yes', 'No', or 'Unknown' and provide details about any limitations if applicable.
5. Fill in the section regarding the worker's release status, including whether they are released to full duty or modified duty, along with relevant dates.
6. Complete sections on physical capabilities such as standing, walking, sitting, lifting, and using hands and feet for repetitive tasks. Be sure to check all applicable boxes.
7. Finally, ensure that a medical service provider signs and dates the form before submission. Additional comments can be added on the back if necessary.

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