Work Status Report
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 are normally clearly specified 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
Related articles
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.
The Building Services Supervisor (BSS) must receive verbal notification of the Return To Work with restrictions. See Return To Work for additional communication requirements.
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