Search results
Google's service, offered free of charge, instantly translates words, phrases, and web pages between English and over 100 other languages.
INSTRUCTIONS FOR COMPLETING DUTY STATUS REPORT (CA-17) SUPERVISOR: Complete Side A and refer the form to the physician to complete Side B. Fill in the address of the Employing Agency and send a copy of this report to the OWCP address noted below. Enter the OWCP file number in the top right corner. PHYSICIAN:
1 sie 2014 · Easily create and download a Duty Status Report (Form CA-17) in PDF or Word format at Templateroller.com. Fill out online or download blank form for free.
Form CA-17: Side A Side A is to be completed by the employee’s supervisor. On this side of the form, the employee’s supervisor must specify which physical actions the injured worker’s job entails and the duration of those actions.
INSTRUCTIONS FOR COMPLETING DUTY STATUS REPORT (CA-17) Complete Side A and refer the form to the physician to complete Side B. Fill in the address of the Employing Agency and the appropriate OWCP District Office in the spaces below. Enter the OWCP file number in the top right corner.
Form CA-17 For common positions in EA, have a pre-prepared CA-17 with the left side completed for the injured worker to provide to their physician. On Form CA-17, the EA should indicate light duty work is available.
Form CA-17 - Duty Status Report: This form is provided for purpose of obtaining a medical duty status report for IW. It may be issued initially with Form CA-16.
