Form OWCP-5c, Work Capacity Evaluation Completed Form Examples and Samples
Explore an example of a completed OWCP-5c form, specifically tailored for a postal worker's work capacity evaluation. This sample provides detailed insights into medical restrictions, physical capabilities, and the necessary steps to accurately fill out the form, offering a practical guide for those needing to complete similar evaluations.
OWCP-5c Example – Work Capacity Evaluation for Postal Worker
How this form was filled:
The form is filled out for a postal worker in 2025, reflecting current medical restrictions and work capacity. The evaluation details restrictions on lifting and time assessments, signed by Dr. Jane Smith.
Information used to fill out the document:
- Name: John Doe
- Occupation: Postal Worker
- Agency: United States Postal Service
- Date of Injury: 02/01/2023
- Restrictions: Lifting limited to 20 pounds
- Standing: No prolonged standing
- Physician Name: Dr. Jane Smith
- Evaluation Date: 04/05/2025
- Signature: Dr. Jane Smith
- Date Signed: 04/05/2025
What this filled form sample shows:
- Accurate assessment of physical capabilities for a postal worker
- Detailed medical restrictions, such as limited lifting
- Proper evaluation by a certified medical professional
- Timely completion reflecting current year requirements
Form specifications and details:
| Use Case: | Evaluating work capacity for a postal worker in 2025 |
| Form Type: | OWCP-5c |
