Employee must report to Custodial Services when treating physician gives work restrictions via DWC Form-073. (shown below)
Concentra (a medical provider) typically sends a different Work Status Report format, but the restrictions should be are normally clearly specified with and include an end date or follow up appointment.
Work Status Report Checklist:
- Ensure that the employee's social security number is blacked or whited out
- Ensure that the report has a specific end date (if there are restrictions listed)
- Ensure that the medical provider has signed and provided a follow up date (if needed)
Contacts
Work Status Reports must be scanned and submitted to the following individuals by email:
TO:
- Training Manager (Currently: Elizabeth Saavedra)
- Senior HR Support Specialist (Currently: Wendy Whipple)
CC:
- HRSS Department Email
- Senior Employee Relations Specialist (Currently: Annette Williams)
- Night or Day Shift Manager (Night - Andy Yanez, Day - Seyfi Yazicioglu)
- **NIGHT ONLY** Training Specialists (Currently: Luis Alvarado, Julian Castillo, and Amy Robertson)
Email Samples
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If the report is missing information or incorrectly filled out, seek assistance from the Training Manager or a senior leadership team member to clarify what options you have to remedy the issue. Typically, a phone call to the provider will clarify any ambiguous work restrictions. |
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The Building Services Supervisor (BSS) must receive verbal notification of the Return To Work with restrictions. See Return To Work for additional communication requirements. |