This government document is issued by Military and Veterans Affairs for use in Colorado
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https://www.google.com/url?client=internal-element-cse&cx=005331801672446424340:-_a_sb2xlqs&q=https://dmva.colorado.gov/sites/dmva/files/Fitness%2520to%2520Return%2520to%2520Work%2520Form%2520.pdf&sa=U&ved=2ahUKEwjxidXW4a6LAxUHVkEAHa3eMVU4ChAWegQIAhAC&usg=AOvVaw30BShNWkcXSuCASG17xec-