Work Restrictions on Form WC164

If the intention is to return the injured worker to his/her regular shift performing regular duties, a simple statement is needed in 6c (e.g., “No work restrictions”). If the intention is to return the injured worker to his/her regular shift but with work restrictions, the specific restrictions must be indicated on the WC164. This will provide further clarification and ensure the injured worker and employer alike understand the provider’s expectations. Additionally, it will assist with WC164 compliance for the Clinic Performance Initiative (CPI).