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Ohio BWC C-143: DEP Physical Work Ability Report

Ohio BWC's Disability Evaluator Panel (DEP) physicians use this one-page report to record an injured worker's physical capacities after an examination. The examiner rates each activity by how much of an eight-hour workday the worker can perform it, from never to continuous, and says whether the restrictions are temporary or permanent. BWC uses the results alongside the examiner's report when deciding disability questions in the claim.

Who completes it

The BWC Disability Evaluator Panel physician completes the whole form from the clinical evaluation and other testing results. The injured worker and employer do not complete any part.

Submitting and payment

How to submit it
The DEP physician returns the signed C-143 to BWC with the examination report; the physician signature is required.
Who pays
The C-143 sets no fee and has no billing section; it is completed as part of a BWC-scheduled DEP examination.

Good to know

  • Restriction classes map to the workday: Never is 0 percent, Occasional 1 to 33 percent, Frequent 34 to 66 percent, and Continuous 67 to 100 percent, with a no-restriction option.
  • Activities rated include bending, squatting or kneeling, twisting, climbing, overhead reach, keyboarding, work with hot or cold substances, and lifting and pushing in weight bands up to over 100 pounds.
  • The form asks whether the worker can grasp, perform repetitive wrist motion and operate foot controls with each side, and which hand is dominant.
  • If the worker takes prescribed medication for the allowed conditions, the examiner states whether the worker can safely operate heavy machinery, drive or perform other critical job tasks.

Get the official form

Download the current version from the source each time; forms change without notice.

Disability Evaluator Panel (DEP) Physician's Report of Work Ability Physical Conditions

Official pagePDF

How this list is checked

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 and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

What is the difference between the C-143 and the C-143 PC?

The C-143 records physical work abilities, such as lifting, reaching and sitting tolerance. The C-143 PC is its companion for cognitive and psychological conditions and rates abilities like following instructions and handling work stress in five restriction classes. Both carry the same BWC-1270 stock number and are completed by DEP examiners.

Does the C-143 ask how many hours the worker can work?

Yes. The examiner gives total hours the injured worker can work per day and per week, and how many hours the worker can sit, walk and stand in an eight-hour day, each marked as continuous or with breaks. If restrictions are temporary, the examiner estimates the dates they will last.