You are here: Home Government ... SSDI: Before You ... Work Activity ...
Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

Work Activity Worksheet

1/1

For any jobs you held, especially your current or last job, have you worked under any special conditions listed below? If yes, note the special condition, employer name and dates. Also describe the condition. 

  •  Had extra help, extra supervision or a job coach
    • ___________________________________________________________________
    • ___________________________________________________________________
    • ___________________________________________________________________
  •  Worked irregular or fewer hours than other workers 
    • ___________________________________________________________________
    • ___________________________________________________________________
    • ___________________________________________________________________
  • Given special equipment because of my condition 
    • ___________________________________________________________________
    • ___________________________________________________________________
    • ___________________________________________________________________
  • Took more rest periods than other workers 
    • ___________________________________________________________________
    • ___________________________________________________________________
    • ___________________________________________________________________
  • Given special transportation to and from work 
    • ___________________________________________________________________
    • ___________________________________________________________________
    • ___________________________________________________________________
  • Had fewer or easier duties than other workers 
    • ___________________________________________________________________
    • ___________________________________________________________________
    • ___________________________________________________________________
  • Allowed to produce less work than other workers 
    • ___________________________________________________________________
    • ___________________________________________________________________
    • ___________________________________________________________________
  • Hired through special training or therapy program 
    • ___________________________________________________________________
    • ___________________________________________________________________
    • ___________________________________________________________________
  • Given work that was suited to my condition 
    • ___________________________________________________________________
    • ___________________________________________________________________
    • ___________________________________________________________________
  • Given special help getting ready for work
    • ___________________________________________________________________
    • ___________________________________________________________________
    • ___________________________________________________________________
  • Other 
    • ___________________________________________________________________
    • ___________________________________________________________________
    • ___________________________________________________________________

If your work activity changed, what was the reason? (note: employer name, and date(s)

  • Stopped working 
    • ___________________________________________________________________
    • ___________________________________________________________________
  • My physical and/or mental condition(s) 
    • ___________________________________________________________________
    • ___________________________________________________________________
  • Special conditions that allowed me to work were removed 
    • ___________________________________________________________________
    • ___________________________________________________________________
  • Changed to a lighter or easier type of work 
    • ___________________________________________________________________
    • ___________________________________________________________________
  • Other
    • ___________________________________________________________________
    • ___________________________________________________________________

Please share how this information is useful to you. 0 Comments

 

Post a Comment Have something to add to this topic? Contact Us.

Characters remaining:

  • Allowed markup: <a> <i> <b> <em> <u> <s> <strong> <code> <pre> <p>
    All other tags will be stripped.