What to Check on a WSIB Functional Abilities Form Checklist

A completed Functional Abilities Form can look thorough while still leaving questions unanswered. A missed date or unclear restriction can create confusion. So can a time limit that does not match the proposed duties. This affects the worker, treating clinic, and employer.

Choose a representative and request help with your WSIB FAF review

To understand what to check on a WSIB functional abilities form, confirm the worker and accident details, signatures, abilities, restrictions, and tolerances. Also check the duration and consistency with proposed work. The form should communicate functional information, not a diagnosis or confidential clinical information.

The Workplace Safety and Insurance Board (WSIB) Functional Abilities Form is also known as Form 2647A. It is an optional tool that helps workplace parties discuss suitable work.

Only a regulated health care practitioner can complete it. A copy is sent to WSIB.

Reviewing the basic details first helps everyone rely on the same information before discussing duties, accommodations, and follow-up.

What Should You Check First on a Completed WSIB Functional Abilities Form?

Start by checking whether the completed form is about the right worker, the right workplace injury or illness, and the right assessment date.

Then confirm that the functional abilities and restrictions are clear enough to compare with the worker's duties. The WSIB Functional Abilities Form is optional.

It can still support planning for a safe return to suitable work.

Choose a representative and request help

1. Confirm the identifying information

Check the worker's name, date of birth, employer information, job type, and the date of the accident or awareness of illness. Confirm that the affected injury or illness area is accurate.

These details connect functional information to the correct claim and work situation. The form also asks whether return to work was discussed. Check that this response reflects what happened.

Look for the assessment date and make sure the form is current for the work-planning conversation. A form can describe abilities at one point in recovery.

If capacity has changed since the assessment, raise that change with the treating health professional and workplace parties. Do not silently rely on an outdated description.

2. Check who should receive the completed pages

Only a regulated health care practitioner can complete the FAF. After completion, pages 2 and 3 should be provided to the worker and/or employer. A copy is sent to the Workplace Safety and Insurance Board.

The worker should ask for and retain a copy. If the form is going to an employer, check that it contains functional abilities information.

It should not include unnecessary diagnostic or confidential clinical information. WSIB guidance says the report should focus on what the worker can do and what restrictions apply.

3. Scan the form for missing answers

Before discussing modified work, check that the practitioner addressed relevant abilities and restrictions. Depending on the situation, this may include walking, standing, sitting, lifting or carrying, stair climbing, bending, twisting, hand use, and workplace exposures.

The form uses practical ranges. Examples include sitting for up to 15 minutes or 15 to 30 minutes.

Other examples include lifting up to 5 kilograms or 5 to 10 kilograms. Confirm that selected ranges make sense for the worker's reported capacity.

Finally, check the duration of each restriction. The FAF includes ranges of 1-2 days, 3-7 days, 8-14 days, or 14+ days. Missing duration information can make a modified-work plan difficult to apply.

Note any blank, contradictory, or unclear response. Ask the appropriate person to clarify it promptly. This checklist supports careful communication. It is not a medical or legal opinion.

Are the Dates, Injury Details, and Signatures Complete?

Check that the completed form identifies the right worker and employer and records the accident or illness date.

It should describe the affected area and job, show the assessment date, and confirm whether return to work was discussed. The worker should check the consent and signature section and keep a copy.

Choose a representative and request help

A careful review starts with the information that connects the form to the correct WSIB claim. Compare the worker's name, date of birth, employer details, and claim number, if available, with other claim records.

A small identification error can make it harder for the right people to connect the functional information to the right file.

Check the dates and work details

Confirm the date of the workplace accident, or the date the worker became aware of an illness or condition, is recorded accurately.
Check the health professional's assessment date. It should identify when the functional information was considered, rather than leaving the timing unclear.
Read the job description or job type carefully. It should be specific enough for the employer to compare the worker's abilities with actual duties.
Confirm that the affected injury or illness area is described consistently with the information the worker and clinic are providing.
Look for the return-to-work discussion question. If the worker and employer have discussed returning to work, the form should reflect that accurately. If they have not, it should not suggest otherwise.

The current official WSIB Functional Abilities Form includes these worker and employer details, along with questions about the assessment and return-to-work discussion. The form communicates functional abilities and restrictions. It is not a place to add unnecessary diagnostic or confidential clinical information.

Review consent, signatures, and copies

The worker signature authorizes disclosure of functional abilities information to the worker, employer, and Workplace Safety and Insurance Board.

Before signing, the worker can ask the clinic to explain unclear wording and should identify factual errors.

The treating health professional completes the clinical portions. The worker and employer should review whether identifying and workplace information is accurate.

Ask how the completed form was sent and retain a complete copy, including all pages. The WSIB says a copy of the completed form is sent to it.

Keeping the same version helps everyone refer to the same information if a restriction, date, or work detail later needs clarification.

Do the Restrictions and Functional Tolerances Match the Worker?

A completed WSIB Functional Abilities Form should describe what the worker can safely do and what needs to be limited. It should also state how long those limits are expected to apply.

Compare each checked box with the worker's actual symptoms and observed tolerance. Example ranges on the form are prompts for discussion, not universal medical limits.

Functional areas to compare with the worker's actual tolerance
Form area	What to check	Useful detail
Walking and standing	Does the selected level match how far the worker can walk and how long they can remain standing?	Distance, time, surface, pace, and whether symptoms increase afterward.
Sitting	Can the worker tolerate the stated period without needing to change position?	Whether movement breaks, alternate sitting and standing, or a different chair are needed.
Lifting and carrying	Are floor-to-waist and waist-to-shoulder activities considered separately?	Weight, frequency, distance carried, load size, and whether both hands are required.
Stairs and other movement	Do stair, ladder, bending, twisting, pushing, or pulling limits reflect the job's actual movements?	Number of steps, repetition, balance demands, and the affected side.
Hands and environment	Are gripping, pinching, overhead work, vibration, equipment, chemicals, heat, cold, noise, or scents addressed where relevant?	Specify the hand, exposure, task, and what happens when the activity is attempted.

Use the form's walking, standing, sitting, lifting and carrying, and stair-climbing fields as a starting point. The current official form gives examples such as walking up to 100 metres or 100 to 200 metres.

It also includes sitting up to 15 minutes or 15 to 30 minutes. Lifting examples include up to 5 kilograms or 5 to 10 kilograms.

These examples do not establish a safe limit for every worker. The health professional's assessment and the worker's experience remain important.

Check the less obvious restrictions as carefully as the headline limits. A worker may lift a light object once but struggle with repeated lifting. Gripping or pinching may be more difficult than carrying.

Bending and twisting may be tolerable briefly but not throughout a shift. Review travel to work, equipment operation, medication side effects without naming medications, and vibration exposure when relevant.

Record the activity, approximate duration or repetition, and the symptoms or loss of function that occur.
Confirm whether the restriction applies for 1 to 2 days, 3 to 7 days, 8 to 14 days, or 14 or more days.
Look for additional comments that explain how the restriction should be applied in practice.
Check the next appointment date so the abilities and restrictions can be reviewed rather than treated as permanent.

The form communicates functional information for return-to-work planning, not diagnostic or confidential clinical information.

If a restriction is missing or too broad to apply to the job, the worker should raise the concern with the treating health professional and employer promptly.

The goal is a clear description that supports suitable work without treating a sample range as a medical rule.

Does the Form Support a Safe Modified-Work Plan?

A modified-work plan should translate the form into specific duties, hours, position changes, breaks, and environmental limits.

Compare each proposed task with the recorded abilities and restrictions. If the plan does not explain how a limit will be respected, ask for clarification before treating the work as suitable.

Start duty by duty. For each task, ask whether it fits the documented limits for walking, standing, sitting, lifting, carrying, stair climbing, bending, twisting, hand use, and environmental exposure.

A task may appear light but still require more standing, reaching, gripping, repetition, or awkward positioning than the form supports.

Hours matter as much as duties. A form may record a sitting tolerance of up to 15 minutes, 15 to 30 minutes, or 30 minutes to one hour.

A proposed shift should explain how the worker can change position before reaching that limit.

Apply the same care to walking distances, lifting ranges, stair use, and other tolerances. Consider whether demands are continuous or occasional, and whether the pace leaves room to stay within the restriction.

Breaks and position changes should be practical, specific, and connected to the documented abilities. Instead of describing work as simply "modified," identify when the worker can sit, walk, stretch, alternate tasks, or rest.

If a restriction applies for a stated period, check whether the plan reflects that duration. It should also include a point for reassessment.

Choose a representative and request help through ClaimIt.

Ontario worker discussing modified work with a treating physiotherapist

Check whether the plan can change when the form changes

Recovery is not always linear. A plan that fits one completed form may no longer fit after a new assessment or updated restrictions.

Confirm who will communicate changes, how the worker can report that a duty is not matching the form, and when the plan will be reviewed.

The WSIB encourages communication of functional abilities information between workplace parties and the health care practitioner. This supports return-to-work planning.

The form should guide that conversation, not replace it. Workers can review proposed duties against their WSIB modified work rights. Raise specific mismatches promptly. ClaimIt is a matching platform, not a law firm or claim decision-maker.

What If the FAF Is Incomplete, Unclear, or Disputed?

If a Functional Abilities Form contains a blank or unclear restriction, do not guess at its meaning. The same applies to a statement that does not match the worker's understanding.

Mark the specific issue and ask the responsible person for clarification. Compare proposed duties with documented abilities and keep every version. The Workplace Safety and Insurance Board (WSIB) encourages communication with the health professional.

Identify the exact problem. Note the page, section, and missing or unclear field. Check walking, sitting, lifting, stairs, hand use, bending, twisting, exposure, treatment needs, and restriction duration. The current WSIB form uses functional categories and duration ranges. Describe the concern in those terms rather than interpreting a diagnosis. A FAF communicates functional abilities and restrictions, not diagnostic or confidential information. See the official WSIB Functional Abilities Form.
Ask the appropriate person to clarify. A treating regulated health professional completes the form. Ask the clinic about unclear medical-functional information and the employer about unclear job duties or the modified-work proposal. Keep the question specific. For example, ask which lifting limit applies or whether sitting can be alternated with standing. Do not ask another party to change a clinical restriction without the health professional's input.
Compare the proposed work duty by duty. Put the documented ability beside each essential or proposed task. Look for mismatches in weight, distance, frequency, posture, pace, environment, or duration. A light-looking duty may still conflict with a restriction when it requires repeated bending, prolonged standing, or a listed exposure. If the plan is unclear, record the missing detail instead of assuming the work is suitable.
Preserve a clear record. Keep a copy of the completed FAF and the version that raised the concern. Keep messages requesting clarification and any revised form or modified-work description. The WSIB states that a copy of the completed form is sent to it. Your own copy helps you compare what was submitted with later discussions. Share only the functional information needed for return-to-work communication.
Get help when the disagreement affects benefits or return to work. If the issue remains unresolved, consider speaking with a WSIB representative. This may be especially important when it affects benefits, work capacity, or the return-to-work plan. ClaimIt is a matching platform, not a law firm or claim decision-maker. It does not provide legal advice. It can help Ontario workers choose a verified WSIB lawyer or paralegal.

Choose a representative and request help through ClaimIt

What Should Workers, Clinics, and Employers Do Next?

After reviewing a WSIB Functional Abilities Form, the worker should confirm that the information reflects current abilities. The treating clinic should correct or clarify functional information.

The employer should use the restrictions to plan suitable work. Each person has a different role. The form should support communication without unnecessary diagnosis or confidential clinical details.

Workers: review, ask questions, and keep your copy

Read the completed form carefully before relying on it for a return-to-work discussion. Check that your name, employer, injury or illness area, job information, and relevant dates are accurate.

Pay particular attention to abilities and restrictions for walking, standing, sitting, lifting, bending, twisting, hand use, stairs, and environmental conditions. The listed tolerances should make sense when compared with what you can do.

Also check how long the restrictions are expected to apply. If a restriction is missing, unclear, or does not reflect your experience, ask the treating health professional to review it.

Retain a copy of the completed form for your records.

If you need to understand when to complete a FAF, use the timing guide separately. Do not assume this form creates a new deadline.

Clinics: provide functional information that can be used

Only a regulated health care practitioner completes the WSIB Functional Abilities Form. The clinic should describe functional abilities, restrictions, and relevant tolerances clearly enough for workplace planning.

It should avoid adding diagnostic or confidential information that the report does not require. When the worker has questions, the health professional's Form 8 article provides related context.

If the worker identifies an omission or error, the clinic can clarify the functional information. It can communicate with the appropriate workplace parties as needed.

The goal is an accurate picture of capacity. It is not a prediction about the claim or a legal conclusion.

Employers: compare restrictions with the actual duties

Employers should use the recorded restrictions to examine the essential and alternative duties being considered. A proposed task should not conflict with a stated limit on lifting, posture, movement, walking, standing, or exposure.

Discuss the available work with the worker and health professional when clarification is needed. Keep the conversation focused on functional abilities rather than diagnosis.

WSIB encourages communication between workplace parties and the health care practitioner to support return-to-work planning. If the form does not answer a practical work question, identify the specific gap and seek clarification instead of guessing.

Frequently Asked Questions

This checklist is general information for Ontario workers, employers, and treating clinics.

A regulated health care practitioner completes the functional portions. Questions about a claim or dispute may require help from a qualified representative.

Who can complete a WSIB Functional Abilities Form?

A regulated health care practitioner completes the form. The practitioner should record functional abilities and work restrictions, rather than diagnostic or confidential clinical information. The WSIB guidance explains the form's intended use.

What should I do if the information on the form is wrong?

Keep a copy and identify the specific omission or disagreement. Raise it promptly with the treating practitioner and relevant workplace contact.

Ask that the functional information be clarified so everyone uses the same record. Avoid changing the practitioner's answers yourself.

Does a completed form include a diagnosis?

No. The form is intended to communicate functional abilities and restrictions that may help with return-to-work planning. WSIB guidance says it should not contain diagnostic or confidential information.

Who receives a completed Functional Abilities Form?

The form includes a worker authorization for functional abilities information to be disclosed to the worker, employer, and WSIB. The WSIB also states that a copy of the completed form is sent to it.

Keep your own copy so you can review what was provided.

Ready to Review Your Next Step?

A completed Functional Abilities Form can raise questions about restrictions, modified work, or information that needs clarification. If you are unsure how it affects your workplace injury or return-to-work concern, ClaimIt can help.

Choose a verified WSIB lawyer or paralegal through our matching platform. Get started by submitting the intake form so a suitable representative can review your situation. The platform is free for injured Ontario workers.