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The document is a Transitional Work Assignment Form for employees who have been injured and are returning to work under medical restrictions. It outlines the employee's details, temporary work restrictions, expected return date, scheduled work hours, and initial work assignments. The form emphasizes the importance of adhering to medical restrictions and notifies that refusal to accept the transitional assignment may affect workers' compensation benefits.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (51 Votes)

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