Return to work clearance letter 2025

1. Click ‘Get Form’ to open the return to work clearance letter in the editor.
2. Begin by entering the physician's name and the employee's name at the top of the form. This personalizes the document and ensures clarity.
3. In section 1, provide a detailed medical diagnosis. This is crucial for understanding the employee's health status.
4. For section 2a, check the appropriate boxes indicating how many hours the employee can sit, stand, and walk during an 8-hour workday. Be precise to reflect their capabilities accurately.
5. In section 2b, indicate how many hours the employee can perform these activities in combination. Choose from options ranging from 2 to greater than 16 hours.
6. Complete section 3a by checking boxes for other capabilities such as lifting and carrying weights. This helps define physical limitations.
7. Fill out sections 3b and 3c regarding upper and lower extremities, ensuring you note any repetitive actions that can be performed.
8. In section 4, assess work environment restrictions by answering yes or no to exposure risks like temperature changes or moving machinery.
9. Section 5 allows you to explain any additional restrictions that may apply based on your examination.
10. Finally, complete sections 6 through 8 regarding return dates and physician’s signature. Ensure all information is accurate before saving your document.

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