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Run: Work Conditioning Evaluation

Work Conditioning Evaluation template for documenting job demands, physical capacity, and task simulation before return-to-work recommendations. Use it to ca...

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Evaluation Details

Referral source and evaluation date documented critical (required)

Job title and essential duties verified critical (required)

Target return-to-work status identified critical (required)

Note (optional)

Relevant medical restrictions reviewed critical (required)

Yes No N/A

Informed consent and participant understanding confirmed critical (required)

Yes No N/A

Job Demand Verification

Lifting demand documented critical (required)

Note (optional)

Carrying demand documented

Note (optional)

Pushing and pulling demand documented

Postural demands documented

Note (optional)

Environmental or safety demands identified

Physical Capacity Testing

Maximal safe lifting tolerance critical (required)

Note (optional)

Carry tolerance

Note (optional)

Push/pull tolerance

Overhead reach tolerance

Note (optional)

Sustained standing or walking tolerance

Note (optional)

Symptom response during testing critical (required)

Note (optional)

Job Task Simulation

Simulated task performance matches essential job demands critical (required)

Yes No N/A

Material handling task completed safely critical (required)

Yes No N/A

Tool use or repetitive task tolerance documented

Work pace and endurance observed

Note (optional)

Need for rest breaks or task modification

Safety, Tolerance, and Recommendations

No unsafe compensatory movement patterns observed critical (required)

Yes No N/A

Vital signs or exertion response monitored as indicated

Yes No N/A

Recommended work status critical (required)

Note (optional)

Recommended restrictions or accommodations

Evaluator signature critical (required)

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