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Disability Report Form Guide (Adults)

Disability Report Form Guide (Adults)

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Section 3 - Information About Your Work

  General Information About Section 3
A. List all the jobs that you had in the 15 years before you became unable to work because of your illnesses, injuries or conditions.
B. Which job did you do the longest?
C. Describe this job. What did you do all day?
D. In this job (the one you described in 3.C), did you use machines, tools, or equipment? Use technical knowledge or skills? Do any writing, complete reports, or perform any duties like this?
E. In this job (the one you described in 3.C) , how many total hours each day did you: walk, stand, sit, climb, stoop, kneel, crouch, crawl, handle, grab, or grasp big objects, write, type, or handle small objects?
F. Lifting and Carrying (Explain what you lifted, how far you carried it, and how often you did this)
G. Check heaviest weight lifted.
H. Check weight frequently lifted (By frequently, we mean from 1/3 to 2/3 of the workday).
I. Did you supervise other people in this job?
J. Were you a lead worker?

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Last reviewed or modified Wednesday Apr 09, 2008
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