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Printable ca-17 Form: What You Should Know

Duties are assigned to employees and, when an employee is injured on the job, the employer or the employee has the right to request a duty status report from the Department of Labor (DOL) and the form, Form CA-17, is used to report a new duty status. Why is a Duty Status Report Form Necessary? The DOL requires the form to be completed upon any new duty assignment. The DOL can use this type of reporting and to verify the duty status of the employee. The form, which is a Federal law as well, can also be used for other purposes such as: To verify previous duty period Filing a wage/hour claim by filing a report with DOL The DOL has a section in a form, (Form CA-13), which asks for the employee's name, address, date of birth and social security number. The DOL cannot report a non-CAL wage or tax for these workers. What Kind of Injury Can Be Claimed as a Duty Status Report? Any injury, including: Minor Severe Wound What If the Employee has More Than One duty? Each worker has multiple duties such as working nights, weekends and holidays (for certain kinds of employee) the employee will also need a copy of the employee's regular job assignment as shown on the employee's personnel record. The DOL may require a duty status report for all the employees in a given work group. Where Can I Download the DWC Form? You can download the Form CA-11(C). . It is available on the DWC website for users outside the U.S. What Happens If I Do Not Complete CA-17? The duty status report form is complete at the time the employee submits it. However, it is the DOL's policy to not accept and process incomplete Form CA-17.  Do I Need a Witness If I Complete CA-17? Yes, an additional witness is needed for each duty assignment. The witness must sign and date the Form CA-17 for the worker to complete it. The DOL only allows two additional witnesses, so the employee must bring both witnesses. Why Did the DOL Release a Duty Status Report Form? If you are a worker, you might be interested in a duty status report and the DOL released this document to help you gather information.

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