What Is the Description of Employee’s Job Duties (DWC Form AD 10133.33)?

The Description of Employee’s Job Duties, also known as DWC Form AD 10133.33, is a form used in California workers’ compensation cases to document the physical and mental requirements of an injured worker’s job. It is used during the return-to-work process when a worker has permanent restrictions that may affect their ability to perform their regular duties.

The form helps the treating physician determine whether the worker can return to their usual position or if modifications or alternative work are needed.

When Is Form AD 10133.33 Used?

This form is typically used after a doctor has determined that the worker’s condition has stabilized and that they have reached maximum medical improvement. It may be required when:

• The employer is evaluating whether it can offer regular, modified, or alternative work
• The physician needs to compare job duties with the worker’s physical restrictions
• There is a question about eligibility for supplemental job displacement benefits (SJDB)

What Information Does the Form Include?

DWC Form AD 10133.33 includes:

• The employee’s job title, department, and employer information
• A summary of the daily job tasks
• Physical requirements, such as lifting, standing, bending, and walking
• Use of machinery or tools
• Work schedule and environmental conditions

This information helps the physician assess whether the job is suitable based on the worker’s limitations.

Who Completes the Form?

The employer is responsible for completing the form. Once it is filled out, the employer must send it to the treating physician and provide a copy to the injured worker.

The physician then reviews the job description and provides a written opinion on whether the employee can return to that job with or without accommodations.

How It Affects Return-to-Work and SJDB

If the physician determines that the worker cannot return to the same position, and the employer cannot offer modified or alternative work, the injured worker may be eligible for a supplemental job displacement benefit voucher.

This form plays a key role in determining eligibility for return-to-work offers and whether retraining benefits will apply.

Need Help Understanding Your Return-to-Work Rights?

If your job description form was not completed correctly, or if you believe you were offered work that does not meet your restrictions, you may have legal options. The Law Offices of Norman J. Homen assists injured workers throughout California with return-to-work disputes and benefit claims.