Requested by the injured worker or their employer, and never started by the clinician, this WSIB form turns your examination into functional abilities and restrictions without any diagnosis. The worker and employer use it to plan an early and safe return to suitable work. You give them pages 2 and 3, and fax, mail or electronically submit the same pages to the WSIB to be paid.
A treating regulated health professional, such as a physician, nurse practitioner, chiropractor, physiotherapist or psychologist, completes Sections C to F based on their own examination. The employer and/or worker complete Section A, and the worker signs the authorization in Section B.
The employer and worker fill in identification, the date of accident or awareness of illness, the type of job at the time of the accident (with a job description or Physical Demands Analysis attached where available), all areas of injury, whether return to work has been discussed, and the employer contact who coordinates the plan. If your patient needs help, assist them; the WSIB asks you to submit the form even if Section A is not fully completed.
The worker signs and dates to authorize any treating health professional to give them, their employer and the WSIB information about their functional abilities on this form. WSIB's guide asks employers to discuss return to work and have the worker sign before the form goes to the health professional, and to explain that only functional abilities, never medical information, will be shared.
Tick your designation, confirm whether you are registered with the WSIB, and enter your WSIB Provider ID, name, address, invoice number and HST details if applicable; the service code is FAF. Sign the declaration that Sections C, D, E and F are true and complete, noting it is an offence to knowingly make a false or misleading statement to the WSIB. The bolded billing area must not be given to the worker or employer.
Enter the date of assessment and check one option: the patient can return to work with no restrictions; can return with restrictions (complete Sections E and F); or is physically unable to return at this time (complete Section F only). WSIB's guide says that if the worker needs more time to heal, you go straight to Section F and give the date the condition will be reassessed.
E1 lists abilities with ranges to tick: walking distance, standing and sitting time, lifting floor to waist and waist to shoulder (in kilograms), stair and ladder climbing, and travel to work by public transit or car. E2 lists restrictions: bending or twisting, work at or above shoulder, chemical or environmental exposure, limited hand use, pushing or pulling, motorized equipment, medication side effects and vibration. Use E3 for maximum times, weights and durations, and E4 for how long it all applies.
E5 records whether you have discussed return to work with your patient; WSIB's guide notes the health professional can help the worker feel comfortable about the value of an early and safe return to regular activities. E6 gives your recommended work hours (regular full-time, modified or graduated) and the start date for the return-to-work plan. Employers build accommodations from these entries, so the WSIB asks for as much detail as possible.
Give the recommended date of the next appointment to review abilities and restrictions; WSIB's guide says this helps the employer plan the return to work and evaluate its success. Then tick whether you gave the completed form to the worker, the employer or both. For billing, fax or mail pages 2 and 3 to the WSIB, which pays once both pages are received.
Download the current version from the source each time; forms change without notice.
Functional Abilities Form for Planning Early and Safe Return to Work
Détermination des capacités fonctionnelles pour la planification d'un retour au travail rapide et sécuritaire
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
Sources for this guide
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Only the worker or the employer. WSIB states that health professionals cannot initiate the FAF, and says it is ideally requested when the worker is functionally able to return to work. If a patient or employer brings one to a follow-up visit, complete it promptly and return pages 2 and 3 to them.
No. The form must contain functional abilities information only, with no diagnostic or confidential information, because the employer receives it. Describe what the worker can and cannot do, with maximum times, weights and durations in E3. Potential medication side effects can be flagged in E2, but the form says not to name the medications.
The WSIB pays a set fee under code FAF when it receives pages 2 and 3, and charges that cost to the employer's account. It does not pay for an FAF completed on the same date as the initial Form 8 or CMS8. If an employer asks you to complete its own form instead, the employer pays you directly.
Section B is the worker's signed authorization to share functional abilities information with the employer and the WSIB, and the employer should have it signed before the form reaches you. WSIB's reporting guidance adds that you do not need consent to share functional abilities information with the employer, and the form asks you to submit it even if Section A is incomplete.