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Why REHAB AT WORK?
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Frequently Asked Questions
Menu
Home
About Us
About Us
Why REHAB AT WORK?
Managers
Careers
Resources
Services
Physical Therapy
Occupational Therapy
Functional Capacity Evaluation (FCE)
Work Hardening/Conditioning Program
Work Site Services
Telehealth
Locations
Alexandria
Baltimore
Columbia
Corporate Office
Frederick
Glen Burnie
Herndon
Lanham
Manassas
Pikesville
Rockville
Waldorf
For Patients
Patient Forms
Billing and Insurance
Frequently Asked Questions
Refer a Patient
Employment Information Form Columbia
The following questions pertain to your position at the time of your injury.
First Name
Last Name
Email
What was the last grade in school you completed?
Length of employment at your company
Years of experience in the field
What other jobs or training have you held (please indicate length of time in each)?
Are you presently working?
Yes
No
If yes, is it in your pre-injury position?
Yes
No
If no, when was your last day of work?
Is your job still available?
Yes
No
What are your plans concerning returning to work?
On a typical day at work, prior to your injury, did you have to (please check all applicable areas)
Sit
Never
Occasional (up to 2.5 hrs.)
Frequent (2.5-5 hrs.)
Constant (over 5 hrs.)
Stand
Never
Occasional (up to 2.5 hrs.)
Frequent (2.5-5 hrs.)
Constant (over 5 hrs.)
Walk
Never
Occasional (up to 2.5 hrs.)
Frequent (2.5-5 hrs.)
Constant (over 5 hrs.)
Squat/Crouch
Never
Occasional (up to 2.5 hrs.)
Frequent (2.5-5 hrs.)
Constant (over 5 hrs.)
Bend/Scoop
Never
Occasional (up to 2.5 hrs.)
Frequent (2.5-5 hrs.)
Constant (over 5 hrs.)
Climb Stairs/Ladders
Never
Occasional (up to 2.5 hrs.)
Frequent (2.5-5 hrs.)
Constant (over 5 hrs.)
Reach
Never
Occasional (up to 2.5 hrs.)
Frequent (2.5-5 hrs.)
Constant (over 5 hrs.)
Crawl
Never
Occasional (up to 2.5 hrs.)
Frequent (2.5-5 hrs.)
Constant (over 5 hrs.)
Kneel
Never
Occasional (up to 2.5 hrs.)
Frequent (2.5-5 hrs.)
Constant (over 5 hrs.)
Awkward postures
Never
Occasional (up to 2.5 hrs.)
Frequent (2.5-5 hrs.)
Constant (over 5 hrs.)
Balance
Never
Occasional (up to 2.5 hrs.)
Frequent (2.5-5 hrs.)
Constant (over 5 hrs.)
On a typical day, prior to your injury, state in lbs. the maximum weight for the appropriate frequency
Lifting from Floor to Waist
Never
Occasional (1-15x/day)
Frequently (16-200x/day)
Constant (>200x/day)
Lifting from Knee to Waist
Never
Occasional (1-15x/day)
Frequently (16-200x/day)
Constant (>200x/day)
Lifting from Waist to Shoulder
Never
Occasional (1-15x/day)
Frequently (16-200x/day)
Constant (>200x/day)
Lifting from Waist to Overhead
Never
Occasional (1-15x/day)
Frequently (16-200x/day)
Constant (>200x/day)
Push
Never
Occasional (1-15x/day)
Frequently (16-200x/day)
Constant (>200x/day)
Pull
Never
Occasional (1-15x/day)
Frequently (16-200x/day)
Constant (>200x/day)
Carry
Never
Occasional (1-15x/day)
Frequently (16-200x/day)
Constant (>200x/day)