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1. Employee Information: Basic details of the employee including name, employee ID, department, position, and contact information
2. Absence Information: Details of the absence period, reason for absence (illness/injury/other), and original date of leave
3. Medical Clearance: Statement from healthcare provider confirming fitness to return to work, including any relevant medical evaluations and certifications
4. Return to Work Details: Specified return date, work schedule, and any modified duty arrangements
5. Work Restrictions: Clear outline of any temporary or permanent work restrictions, modifications, or accommodations required
6. Employee Declarations: Employee's confirmation of ability to perform duties and acknowledgment of any restrictions
7. Employer Acknowledgment: Employer's confirmation of understanding and acceptance of return conditions
8. Authorization Signatures: Signature sections for employee, healthcare provider, and authorized company representative
1. COVID-19 Declarations: Additional declarations specific to COVID-19 protocols, required if return is related to COVID-19 or during pandemic conditions
2. Graduated Return Plan: Detailed plan for phased return to full duties, needed when employee requires gradual resumption of responsibilities
3. Follow-up Requirements: Schedule of follow-up medical evaluations or check-ins, included when ongoing monitoring is necessary
4. Workplace Modifications: Detailed description of specific workplace modifications or accommodations, required when physical workplace changes are needed
5. Risk Assessment: Assessment of workplace risks relative to employee's condition, included for cases involving occupational injuries or chronic conditions
1. Medical Certificate: Attached medical certification from healthcare provider confirming fitness for work
2. Duty Restrictions List: Detailed list of specific duty restrictions or modifications if applicable
3. Accommodation Plan: Detailed plan of workplace accommodations or modifications if required
4. Follow-up Schedule: Timeline of required follow-up medical evaluations or check-ins if applicable
Healthcare
Manufacturing
Construction
Information Technology
Retail
Education
Financial Services
Mining
Transportation
Hospitality
Government Services
Business Process Outsourcing
Agriculture
Energy
Telecommunications
Human Resources
Occupational Health and Safety
Legal
Compliance
Risk Management
Employee Relations
Medical Services
Operations
Facilities Management
Administration
Human Resources Manager
HR Business Partner
Occupational Health and Safety Manager
Compliance Officer
Risk Management Officer
Employee Relations Manager
Benefits Administrator
HR Director
Workplace Safety Coordinator
Medical Services Coordinator
Department Manager
Line Supervisor
Operations Manager
Facility Manager
Legal Counsel
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