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Duty Status Report Reset Print U.S. Department of Labor Office of Workers ' Compensation Programs This form is provided for the purpose of obtaining a duty status report for the employee named below.

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Duty Status Report
INSTRUCTIONS FOR COMPLETING DUTY STATUS REPORT (CA-17). Complete Side A and refer the form...
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The types of injuries of duties (IOD) range from minor contusions to amputations of digits. Other injuries include removal of foreign bodies in the eyes and in the skin as a result of, for example, grinding metal. Burns, abrasions and lacerations are all in a days work.

Instructions for Completing Form CA-7A Time Analysis. General: This form is used when claiming FECA compensation, including repurchase of paid leave. It must be used when claiming compensation for more than one consecutive period of leave.

The employer is required to maintain the same level of health insurance benefits the worker had while he was employed. If the worker has to be off of work longer than the allotted 12 weeks, the employer may cancel the health insurance benefits.

It is recommended that you take with you a form CA-17 - Duty Status Report to give to the attending physician. This form provides your supervisor and OWCP with interim medical reports containing information as to your ability to return to any type of work.

Employing agency (EA) should submit completed Form CA-7 to the Office of Workers' Compensation Programs (OWCP) within five work days of receipt from IW. OWCP tries to review wage loss claims within five days of receipt, and take action to develop or pay within 14 days of receipt from EA.

CA-17 - Duty Status Report. This form allows the physician to keep your supervisor updated on your work restrictions and/or duty status.

There are two sides to the CA-17: Side A is completed by the employee's supervisor and Side B is completed by the employee's physician. A properly completed CA-17 should give the doctor an accurate picture of a worker's daily work duties so that accurate work restrictions can be noted.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232