bluehive.com/services/fitness-for-duty-evaluation/prepare
Preparation Checklist
Check off each item as you prepare for your appointment.
What to Bring
5 itemsHow to Prepare
2 itemsGeneral
1 itemWhat to Expect
Here's what will happen during your visit.
Request Evaluation
Employer requests FFD evaluation with job description and specific concerns.
Schedule Assessment
Employee is scheduled with a qualified evaluating physician.
Complete Evaluation
Physician conducts comprehensive evaluation based on job requirements.
Receive Determination
Employer receives fitness determination and any recommended restrictions or accommodations.
Need Help?
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Forms typically used during a Fitness for Duty Evaluation visit
BlueHive doesn't fill out forms — providers do. These are the official forms a provider may use during this visit so you know what to expect.
- USCG MarinerCG-719K
Application for Merchant Mariner Medical Certificate
CG-719K is the medical evaluation form a licensed practitioner completes for any mariner applying for or renewing a Merchant Mariner Credential (MMC) or Medical Certificate. The National Maritime Center reviews submissions and issues the certificate.
View form details - Workers’ Comp
Physician's Report
Physician's Report — state-prescribed clinician report used by the state workers’ comp agency.
View form details - Workers’ CompICA Form 102
Worker's and Physician's Report of Injury
Worker's and Physician's Report of Injury (ICA Form 102) — state-prescribed clinician report used by the state workers’ comp agency.
View form details