Return to work clearance letter 2026

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 identifies who is completing the assessment and who it pertains to.
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 sure to include both continuous and rest periods.
5. In section 2b, specify how many hours can be spent sitting, standing, or walking in combination throughout a day.
6. Complete section 3a by checking off capabilities such as lifting and carrying weights. This helps outline physical limitations.
7. Fill out sections 3b and 3c regarding upper and lower extremities, indicating dominance and ability for repetitive actions.
8. In section 4, assess any work environment restrictions that may affect the employee’s ability to perform their job safely.
9. Section 5 allows you to explain any additional restrictions that may apply based on your examination.
10. Finally, indicate whether the employee can return with or without restrictions in sections 7 and 8. Ensure you sign and date at the bottom before submitting.

Start using our platform today for free to streamline your document editing process!