Medical release to return to work 2012 form-2026

1. Click ‘Get Form’ to open the medical release to return to work 2012 form in the editor.
2. Begin by filling in your personal details in the 'TO BE COMPLETED BY THE EMPLOYEE' section. Enter your name, UT EID, shift, department, and contact numbers.
3. Sign the form at the bottom of this section and indicate your last day worked along with the date of signing.
4. Move to the 'TO BE COMPLETED BY THE HEALTHCARE PROVIDER' section. The healthcare provider should indicate whether the condition is work-related and provide a return date with or without restrictions.
5. Fill out any applicable work restrictions, including maximum lifting and pushing/pulling weights, as well as any other specific limitations.
6. Ensure that the healthcare provider signs and provides their contact information before submitting it to your supervisor.

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