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Usps light duty request form

Usps light duty request form 2026

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The document outlines a request process for employees seeking temporary light duty assignments due to non-work related injuries or illnesses. It includes sections for the employee to provide personal and medical information, as well as for supervisors and management to assess and approve or deny the request based on medical documentation. The document emphasizes that light duty is an accommodation, not a 'make work' situation, and details privacy considerations regarding the handling of personal information.

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In Part A, enter your printed name, signature, and date. Provide your Social Security Number, position, office/tour, duty hours/NS days, phone number, HMO number (if applicable), physician's name and specialty, address, and telephone number.
In Part B, your immediate supervisor will indicate if work is available in your unit by checking the appropriate box and signing with the date.
Part C requires the Postmaster or Plant Manager to approve or deny light duty. They will fill in the dates for approval if applicable and provide their signature and printed name.
If light duty is approved for 90 days or more, Part D must be completed by the USPS District Medical Officer with their signature and date.

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