Fitness for duty form 2026

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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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