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Form last updated: 03/2024. Please verify this is the current version before use.
Easily complete & submit your CA-17 form
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What is a CA-17 used for?
Form CA-17 is used to report an employee's work status following an injury. It helps assess the employee's ability to return to work and outlines any necessary work restrictions. This form provides important information to employers and the Office of Workers' Compensation Programs (OWCP) for managing workers' compensation claims.
Who needs to fill out a CA-17 form
The employee's supervisor and the treating physician are required to complete this form.
How to fill out a CA-17 online?
Follow these steps to complete your CA-17 form online.
Frequently Asked Questions
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It documents an employee's work status and injury details to assist in workers' compensation claims.
Side A is filled out by the supervisor, while Side B is completed by the treating physician.
The form should be submitted promptly after the physician completes it.
You can obtain a blank form from the Office of Workers' Compensation Programs (OWCP) website or your employing agency.
It should be sent to the Office of Workers' Compensation Programs (OWCP) and a copy retained by your employing agency.
