WebFill out each fillable field. Make sure the data you add to the CA DWC AD 10133.36 is updated and accurate. Indicate the date to the record with the Date function. Click on the … WebFor injuries occurring on or after 1/1/13 also complete DWC-AD Form 10133.36 Limited, but retains MAXIMUM capacities to LIFT (including upward pulling) and/or CARRY: ... (You may attach form DWC-AD 10133.33 for injuries occurring on or after 1/1/13): Sheet 5 of 6 DWC Form PR-4 (Rev. 02/2016)
Form 10133.36 Download Fillable PDF or Fill Online …
WebFollow these simple actions to get CA DWC AD 10133.36 prepared for submitting: Select the form you need in our library of templates. Open the form in our online editor. Read … WebMar 29, 2024 · The form I received today is the (DWC-AD 10133.35 form). My hesitation in signing this form is the wording on page 4 (the signature page), which states "I … sharon atherton
DWC Forms - California Department of Industrial Relations
WebCal/OSHA - Safety & Health. Cal/OSHA Back; Consulting; Enforcement; Heat Illness Preclusion; Injury & Disease Prevention Program WebThe defendant upon receipt of the PQME report, was placed on notice of the industrial PD and work restrictions, but apparently did not provide the PQME with the required Physician’s Return-to-Work & Voucher Report (Form DWC-AD 10133.36), a form designed to provide defendant with notice the injured worker has become P&S, with industrially-caused … http://www.das.ca.gov/DWC/FORMS/SJDB/10133.35.pdf sharon atkins facebook