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Physician Form

Functional Abilities Form - WSIB Early and Safe Return to Work

A downloadable Physician form for healthcare professionals.
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About this form

The Functional Abilities Form supports the planning of an early and safe return to work for patients following injury or illness. It is used to assess a patient’s functional capabilities and readiness to resume work duties. The form captures essential information, including patient details, relevant clinical history, and assessment findings. Completing this form in Heidi supports structured documentation and assists clinicians in providing clear information to inform return-to-work planning.

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How to use this form

1

Download the PDF

Click the download button to save the form to your device

2

Print or fill digitally

Print the form for handwritten use or fill it out using a PDF editor

3

Use in your practice

Integrate the completed form into your patient records and workflows

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Specialty

Physician

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Form

Last edited

26/01/2026

Created by

Heidi Team

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  • Médecine générale

  • Médecine spécialisée

  • Paramédical

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