🔗 Linked Evidence
OFA_BLANK_MARCH_24 — p.2
📄 OFA BLANK MARCH 24 | p.2
📄 OFA BLANK MARCH 24 | p.2
📝 Extracted Text (OCR)
bertc OCCUPATIONAL FITNESS ASSESSMENT (OFA) CONFIDENTIAL INFORMATION (To be completed by attending physician) Mark Holand E21987 Job Title: Date of Birth: Guideway Serviceperson Safety Critical OSafety Sensitive Please refer to Canadian Railway Medical Rules Handbook for Positions Critical to Safe Railway Operations, https://www.railcan.ca/publication/canadian-railway-medical-rules-handbook/ Date of injury/illness: cl Occupational c _Non-Occupational General Nature of Illness/injury (specific diagnosis not required): Secondary Nature of Illness (if any): Is there a recommended Treatment Plan: c Yes ca No Patient is compliant with Recommended Treatment: co Yes a No Date of most recent visit: Next planned visit: Is your patient taking any medication that could impact their ability to perform work safely and productively? co Yes oO No If so, please explain limitations and restrictions: Other Referred Treatment Providers (if any): s the patient medically cleared to return to full duties without any limitation and restriction? Yes, skip to signature page (page 4)