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 clearly specified with an end date.
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:
If the report is missing 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.