WSIB Functional Abilities Form: Field-by-Field Guide

The WSIB Functional Abilities Form (FAF)

If you're treating an injured worker in Ontario, you'll be asked to complete the Functional Abilities Form (FAF) for the Workplace Safety and Insurance Board (WSIB).

The FAF is a critical document. It determines:

• Whether the worker can return to work
• What modifications or restrictions are needed
• Whether the worker qualifies for loss of earnings benefits

This post provides a field-by-field guide to completing the FAF accurately and defensibly.

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What Is the Functional Abilities Form?

The FAF is a standardized form used to communicate a worker's functional abilities to the employer and WSIB. It's completed by the treating health care provider (physician, chiropractor, physiotherapist, or nurse practitioner).

Purpose:

• To identify what the worker can do, not just what they can't do
• To facilitate return-to-work planning
• To provide objective information about functional limitations

Key principle: Focus on abilities, not disabilities.

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Field-by-Field Guide

Section A: Worker Information

Field 1: Worker's Name

• Enter the worker's full legal name (as it appears on WSIB claim)
• Ensure spelling is correct

Field 2: Date of Birth

• Enter in DD/MM/YYYY format
• Verify against health records

Field 3: Claim Number

• Enter the WSIB claim number (8-digit number)
• If unknown, leave blank or write "pending"

Field 4: Date of Injury

• Enter the date of the work-related injury
• Use DD/MM/YYYY format

Field 5: Body Part(s) Affected

• Be specific (e.g., "right shoulder," "lumbar spine")
• Use anatomical terminology

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Section B: Health Care Provider Information

Field 6: Health Care Provider Name

• Enter your full name and credentials (e.g., "Dr. Jane Smith, MD")

Field 7: Practice Name and Address

• Enter your clinic name and full address
• Include phone and fax numbers

Field 8: Date of Assessment

• Enter the date you assessed the worker for this form
• Must be a recent assessment (ideally within 7 days)

Field 9: Provider Type

• Check the appropriate box: Physician, Chiropractor, Physiotherapist, Nurse Practitioner

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Section C: Diagnosis and Prognosis

Field 10: Diagnosis

• Enter the primary diagnosis related to the work injury
• Use specific diagnostic terminology (e.g., "right rotator cuff tendinopathy," "lumbar disc herniation L4-5")
• Avoid vague terms (e.g., "back pain," "shoulder injury")

Field 11: Expected Recovery Time

• Check the appropriate box:
  • Less than 4 weeks
  • 4-8 weeks
  • More than 8 weeks
  • Unknown
• Base this on typical recovery patterns for the diagnosis, not just the worker's report

Field 12: Is Surgery Planned?

• Check Yes or No
• If Yes, provide expected date

Field 13: Is Further Investigation Planned?

• Check Yes or No
• If Yes, specify (e.g., "MRI pending," "EMG scheduled")

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Section D: Functional Abilities

This is the core section. It assesses the worker's ability to perform specific tasks.

Field 14: Sitting

What to assess:

• How long can the worker sit continuously?
• How long can the worker sit total in a workday?
• Are there position changes needed?

How to complete:

• Check the appropriate box: No limitations, Some limitations, Unable to perform
• If "Some limitations," specify:
  • Maximum continuous sitting time (e.g., "30 minutes")
  • Maximum total sitting time per day (e.g., "4 hours")
  • Reason for limitation (e.g., "increased low back pain after 30 minutes")

Example:

• "Some limitations. Maximum continuous sitting: 30 minutes. Maximum total per day: 4 hours. Reason: Low back pain increases with prolonged sitting."

Field 15: Standing

What to assess:

• How long can the worker stand continuously?
• How long can the worker stand total in a workday?
• Are there position changes needed?

How to complete:

• Check the appropriate box: No limitations, Some limitations, Unable to perform
• If "Some limitations," specify:
  • Maximum continuous standing time
  • Maximum total standing time per day
  • Reason for limitation

Example:

• "Some limitations. Maximum continuous standing: 15 minutes. Maximum total per day: 2 hours. Reason: Right knee pain increases with standing."

Field 16: Walking

What to assess:

• How far can the worker walk?
• How long can the worker walk continuously?
• Are there terrain restrictions (e.g., uneven surfaces)?

How to complete:

• Check the appropriate box: No limitations, Some limitations, Unable to perform
• If "Some limitations," specify:
  • Maximum distance (e.g., "100 meters")
  • Maximum continuous walking time
  • Terrain restrictions (e.g., "must avoid uneven surfaces")
  • Reason for limitation

Example:

• "Some limitations. Maximum distance: 100 meters. Maximum continuous walking: 10 minutes. Terrain: Flat surfaces only. Reason: Right ankle instability."

Field 17: Lifting

What to assess:

• How much can the worker lift from floor to waist?
• How much can the worker lift from waist to shoulder?
• How much can the worker lift above shoulder?
• Are there frequency restrictions (occasional, frequent, constant)?

How to complete:

• Check the appropriate box for each level: No limitations, Some limitations, Unable to perform
• If "Some limitations," specify:
  • Maximum weight for each level
  • Frequency (occasional = 0-33% of time, frequent = 34-66%, constant = 67-100%)
  • Reason for limitation

Example:

• "Floor to waist: Some limitations. Maximum weight: 10 lbs. Frequency: Occasional. Reason: Low back pain with lifting."
• "Waist to shoulder: Some limitations. Maximum weight: 5 lbs. Frequency: Occasional. Reason: Right shoulder pain."
• "Above shoulder: Unable to perform. Reason: Right shoulder impingement."

Field 18: Carrying

What to assess:

• How much can the worker carry in front of the body?
• How much can the worker carry at the side?
• Are there distance restrictions?

How to complete:

• Check the appropriate box: No limitations, Some limitations, Unable to perform
• If "Some limitations," specify:
  • Maximum weight
  • Maximum distance
  • Reason for limitation

Example:

• "Some limitations. Maximum weight: 10 lbs. Maximum distance: 20 meters. Reason: Right shoulder pain with carrying."

Field 19: Pushing/Pulling

What to assess:

• How much force can the worker push/pull?
• Are there height restrictions (e.g., at waist level vs. above shoulder)?
• Are there frequency restrictions?

How to complete:

• Check the appropriate box: No limitations, Some limitations, Unable to perform
• If "Some limitations," specify:
  • Maximum force
  • Height restrictions
  • Frequency
  • Reason for limitation

Example:

• "Some limitations. Maximum force: 20 lbs. Height: Waist level only. Frequency: Occasional. Reason: Low back pain with pushing/pulling."

Field 20: Bending/Twisting

What to assess:

• Can the worker bend forward?
• Can the worker twist?
• Are there frequency restrictions?

How to complete:

• Check the appropriate box: No limitations, Some limitations, Unable to perform
• If "Some limitations," specify:
  • What movements are limited
  • Frequency
  • Reason for limitation

Example:

• "Some limitations. Forward bending: Limited to 45 degrees. Twisting: Limited to 30 degrees. Frequency: Occasional. Reason: Low back pain with bending/twisting."

Field 21: Climbing

What to assess:

• Can the worker climb stairs?
• Can the worker climb ladders?
• Are there height restrictions?

How to complete:

• Check the appropriate box: No limitations, Some limitations, Unable to perform
• If "Some limitations," specify:
  • What climbing is limited
  • Height restrictions
  • Reason for limitation

Example:

• "Some limitations. Stairs: Can climb 1 flight. Ladders: Unable. Reason: Right knee pain and instability."

Field 22: Kneeling/Crouching

What to assess:

• Can the worker kneel?
• Can the worker crouch/squat?
• Are there duration restrictions?

How to complete:

• Check the appropriate box: No limitations, Some limitations, Unable to perform
• If "Some limitations," specify:
  • What positions are limited
  • Maximum duration
  • Reason for limitation

Example:

• "Unable to perform. Reason: Right knee pain prevents kneeling/crouching."

Field 23: Reaching

What to assess:

• Can the worker reach forward?
• Can the worker reach overhead?
• Are there height or weight restrictions?

How to complete:

• Check the appropriate box: No limitations, Some limitations, Unable to perform
• If "Some limitations," specify:
  • What reaching is limited
  • Height restrictions
  • Weight restrictions
  • Reason for limitation

Example:

• "Some limitations. Forward reaching: No limitations. Overhead reaching: Limited to shoulder height. Reason: Right shoulder impingement."

Field 24: Handling/Fingering

What to assess:

• Can the worker use hands for gross motor tasks (handling)?
• Can the worker use fingers for fine motor tasks (fingering)?
• Are there dexterity limitations?

How to complete:

• Check the appropriate box: No limitations, Some limitations, Unable to perform
• If "Some limitations," specify:
  • What tasks are limited
  • Reason for limitation

Example:

• "Some limitations. Handling: No limitations. Fingering: Limited fine motor tasks with right hand. Reason: Right carpal tunnel syndrome."

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Section E: Other Limitations

Field 25: Other Limitations

• Document any other functional limitations not covered above
• Examples:
  • "Cannot work at heights due to vertigo"
  • "Cannot work in cold environments due to Raynaud's"
  • "Cannot operate heavy machinery due to medication effects"

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Section F: Return-to-Work Recommendations

Field 26: Can the Worker Return to Work?

• Check the appropriate box:
  • Yes, to regular duties
  • Yes, to modified duties (specify below)
  • No

Field 27: If Modified Duties, Specify Restrictions

• List specific restrictions (e.g., "No lifting over 10 lbs," "No overhead reaching," "Sedentary duties only")
• Be specific and measurable

Field 28: Expected Duration of Restrictions

• Provide an estimated duration (e.g., "4-6 weeks," "3 months," "Permanent")
• Base this on prognosis and expected recovery

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Section G: Health Care Provider Signature

Field 29: Signature

• Sign the form
• Ensure signature matches the name in Field 6

Field 30: Date

• Enter the date of completion
• Must match the date in Field 8

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Common Mistakes to Avoid

1. Vague Limitations

Wrong: "Limited lifting" Right: "Maximum lifting: 10 lbs, floor to waist, occasional"

2. Inconsistent Limitations

Wrong: "Unable to stand" but "No limitations with walking" Right: Ensure limitations are consistent with the diagnosis

3. No Objective Basis

Wrong: Limitations based solely on worker's self-report Right: Base limitations on objective clinical findings

4. Overly Restrictive

Wrong: "Unable to perform all duties" without specific limitations Right: Identify what the worker can do, not just what they can't

5. No Duration

Wrong: Restrictions without expected duration Right: Provide an estimated duration for restrictions

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Key Takeaways

1. The FAF focuses on abilities, not disabilities.
2. Be specific and measurable in all limitations.
3. Base limitations on objective clinical findings.
4. Provide expected duration for all restrictions.
5. Ensure limitations are consistent with the diagnosis.
6. Avoid vague or overly restrictive language.

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What's Next?

In our next post, we'll tackle "HCAI OCF-18 and OCF-23: What Adjudicators Look For" — the third in our Canadian series.

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This post is part of our series on Canadian medical-legal documentation. For more, see our Ontario SABS Medical Records Guide.

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Questions for Readers:

• What challenges have you faced completing the FAF?
• How do you handle discrepancies between worker self-report and objective findings?
• What's your approach to estimating duration of restrictions?