6 Occupational information

Please ensure section 6 is completed by the plan member’s supervisor.

If you are not the plan member's supervisor, you can download this sectionopens in new window and give it to the supervisor to complete. You can also attach the completed supervisor's statement here before submitting this claim, if available.

Please attach a physical demands analysis if available.

Completed by:

Last name

First name

Job title

Date completed


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What was the plan member's occupation immediately prior to the plan member stopping work?

Were the plan member's duties and/or hours modified from their regular occupation?

Yes No

When?


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Please describe this plan member's regular duties (or attach a copy of the company's job description) as well as any modifications, if any.

If available, attach a physical demands analysis and a copy of the company’s job description.

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