Fitness for duty form 2026

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4 out of 5

35 votes

The document is a Fitness For Duty Certificate for Fairfax County Public Schools, which must be completed by an employee's healthcare provider to confirm their medical readiness to return to work. It includes sections for employee information, physician assessment of the employee's ability to resume work, and instructions for submission to Liberty Mutual.

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Click ‘Get Form’ to open the fitness for duty certificate in our editor.
Begin by entering your personal information in the designated fields, including your name, employee ID, position, and contact numbers.
Next, provide your manager's name and phone number to ensure proper communication regarding your return to work.
Sign the authorization section allowing your healthcare provider to share necessary information about your fitness for duty.
Instruct your physician to complete their section by indicating whether you can resume normal work and perform essential job functions.
Ensure that the physician includes their signature, date, and contact details before finalizing the document.
Once completed, fax the form to Liberty Mutual as instructed and keep a copy for your records when returning to work.

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Versions	Form popularity	Fillable & printable
2016	4.2 Satisfied (29 Votes)
2009	4 Satisfied (35 Votes)

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Why is it important to be fit for duty?

Employees who are not physically fit for their jobs are more likely to get injured, leading to costly compensation claims and downtime. Fit for Duty tests help prevent injuries by ensuring employees can handle the job demands without risking their health.

How to assess fitness for duty?

What Does a Fit-for-Duty Exam Consist of? A review of the employees medical history. A physical exam. An assessment of the employees mental and emotional state. A job analysis. A review of any relevant medical records or test results.

What are some ways to know if you are fit-for-duty?

Fitness for Duty. Medical evaluations under this Program are required in order for the Agency to determine if covered employees are physically and medically capable of performing the essential duties of the position efficiently and without posing a hazard to themselves or others.

What is fit for duty?

What does fitness for duty mean? An employee is fit for duty when they are able to perform their essential job functions, with or without a reasonable accommodation, in a manner that does not pose a direct threat.

How do you assess fitness for duty?

By comparing their knowledge of the working environment and the specific demands of the occupation with their medical assessment of an individuals current mental, physical and medical capacity, they can identify any conditions that could make a person unfit for duty.

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How do you assess fitness?

What Does a Fit-for-Duty Test Involve? Audiometric Testing. This test checks if your employees hearing is adequate to perform their job safely, especially in noisy environments. Vision Testing. Functional Testing. Respirator Medical Evaluation and Pulmonary Function Testing.

Fitness for duty form 2026

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