Work Conditioning Evaluation

Inspection template for documenting physical demand testing, job task simulation, and tolerance to support return-to-work readiness recommendations.

Evaluation Details

• Referral source and evaluation date documented
• Job title and essential duties verified
• Target return-to-work status identified
• Relevant medical restrictions reviewed
• Informed consent and participant understanding confirmed

Job Demand Verification

• Lifting demand documented
• Carrying demand documented
• Pushing and pulling demand documented
• Postural demands documented
• Environmental or safety demands identified

Physical Capacity Testing

• Maximal safe lifting tolerance
• Carry tolerance
• Push/pull tolerance
• Overhead reach tolerance
• Sustained standing or walking tolerance
• Symptom response during testing

Job Task Simulation

• Simulated task performance matches essential job demands
• Material handling task completed safely
• Tool use or repetitive task tolerance documented
• Work pace and endurance observed
• Need for rest breaks or task modification

Safety, Tolerance, and Recommendations

• No unsafe compensatory movement patterns observed
• Vital signs or exertion response monitored as indicated
• Recommended work status
• Recommended restrictions or accommodations
• Evaluator signature