Functional Capacity Evaluation
[YOUR COMPANY NAME]
Name | |
Evaluation Date | |
Evaluator Name | |
Introduction:
This Functional Capacity Evaluation (FCE) is designed to assess an individual's readiness to return to work following an injury or illness. The evaluation aims to provide a comprehensive understanding of the individual's physical and cognitive abilities, as well as any limitations that may impact their ability to perform essential job tasks safely and effectively.
Background:
Returning to work after an injury or illness requires careful consideration of the individual's functional abilities to ensure a safe and successful transition. This evaluation is essential for employers, healthcare providers, and rehabilitation professionals to determine appropriate accommodations, develop return-to-work plans, and support the individual in resuming work activities.
Evaluation Criteria:
Physical Strength and Endurance: Evaluate the individual's ability to perform physical tasks such as lifting, carrying, pushing, and pulling.
Range of Motion: Assess the individual's flexibility and joint mobility, particularly in areas relevant to their job duties.
Balance and Coordination: Determine the individual's ability to maintain balance and coordination while performing various work-related tasks.
Functional Mobility: Evaluate the individual's ability to move safely and efficiently in different environments, including walking, climbing stairs, and navigating obstacles.
Manual Dexterity: Assess fine motor skills and hand-eye coordination necessary for tasks such as typing, writing, and operating equipment.
Cognitive Functioning: Evaluate attention, memory, problem-solving, and other cognitive abilities essential for job performance.
Pain Management: Assess the individual's ability to manage pain effectively during work activities and identify any limitations related to pain.
Work Simulation: Provide opportunities for the individual to perform tasks similar to those required in their job role to assess readiness and identify potential challenges.
Evaluation Table:
Criteria | Assessment | Rating (1-5) |
|---|
Physical Strength and Endurance | Used manual muscle testing and lifting tasks. Assessed endurance with carrying weights. | |
Range of Motion | Conducted goniometry measurements and functional movement assessments. | |
Balance and Coordination | Administered balance tests and coordination exercises. | |
Functional Mobility | Observed walking gait and ability to navigate stairs. | |
Manual Dexterity | Assessed grip strength and fine motor skills. | |
Cognitive Functioning | Conducted cognitive tests and problem-solving tasks. | |
Pain Management | Used pain scales and identified pain triggers. | |
Work Simulation | Simulated job-specific tasks and evaluated safety awareness. | |
Rating Scale:
1: Severe limitation, unable to perform tasks.
2: Significant limitation, requires substantial assistance or accommodation.
3: Moderate limitation, able to perform tasks with some difficulty.
4: Mild limitation, able to perform tasks with minimal difficulty.
5: No limitations, able to perform tasks without difficulty.
Additional Comments and Notes
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