Resources by type Employer Form

For free copies of this resource, email wcb@wcb.mb.ca with the resource name and quantities.

This resource is also available in the following languages: French

Many workplaces have developed their own unique Functional Abilities Forms for workers to bring to their healthcare providers. The form provides an avenue for healthcare professionals to outline the worker's abilities and prognosis. This can provide the employer with information to clarify the workers functional capabilities and assist in the development of a return to work plan for small businesses, or return to work programs for medium to large businesses.

Healthcare providers typically request a fee to complete Functional Abilities Forms. If your company has developed this type of form it is important that you also budget to pay for the completion of these forms and communicate the process to the worker. If an employer is requesting completion of a form then it is the employer's responsibility to pay the healthcare provider for completion of the form. Failure to address this issue may become a barrier to having the form completed and returned.

The employee should be provided with directions to bring the completed form to you right after the medical appointment (before the next available shift) so modified or alternate duties can start at that time. This is then an opportunity to further clarify modified or alternate duties, work hours, and any other question the employee may have.

These documents should be printed double-sided so the directions are not separated from the form.

• Physical Abilities Form

This resource is also available in French

• Cognitive Abilities Form

This resource is also available in French