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Fitness For Duty Certificate - fcps 2026

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The document is a Fitness For Duty Certificate from Fairfax County Public Schools, designed to facilitate an employee's return to work after a medical leave. It requires completion by both the employee and their physician, detailing the employee's health status, any limitations on their work capabilities, and necessary documentation to be submitted to Liberty Mutual before resuming work.

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Click ‘Get Form’ to open the Fitness For Duty Certificate in the editor.
Begin by entering your Claim Number and Date of Injury/Illness at the top of the form. This information is crucial for tracking your case.
Fill in your personal details, including your name, Employee ID (not SSN), position, and contact numbers. Ensure accuracy for seamless communication.
Authorize your health care provider by signing and dating the designated section. This allows them to share necessary information regarding your return to work.
In the physician's section, ensure that they check the appropriate work status box—either full duty or with limitations—and provide a return date if applicable.
Complete any cognitive or physical limitations sections as instructed by your physician. Be specific about any restrictions or required accommodations.
Finally, have your attending physician sign and date the form, ensuring all fields are filled out correctly before submission.

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

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Can an employer approve FMLA without certification?

If an employee does not provide either a complete and sufficient certification or an authorization allowing the health care provider to provide a complete and sufficient certification to the employer, the employees request for FMLA leave may be denied.

What is a fitness for duty certification?

An employer may seek fitness-for-duty certification only with regard to the particular health condition that caused the employees need for FMLA leave. The certification from the employees health care provider must certify that the employee is able to resume work.

What is fitness for duty certification?

Fitness for Duty (FFD), also known as Fitness for Duty Evaluations (FFDE) are medical examinations conducted by a physician to determine whether an employee is fit (physically, mentally, or emotionally) to perform essential job functions.

What makes you fit-for-duty?

The goal of a fit-for-duty exam is to determine whether the employee can safely perform their job duties without posing a risk to themselves or others. As an occupational medicine physician, you would consider the employees medical condition, limitations, and the physical and mental demands of their job.

Why are doctors hesitant to fill out FMLA paperwork?

Because of doctors workloads and the inability in many situations to render a precise prognosis about the frequency and duration of a condition, it can be a challenge when they have to complete patients FMLA request forms.

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Who fills out the fitness for duty form?

The employee is required to provide a complete and sufficient Fitness for Duty Certification, completed by his or her health care provider, prior to returning to work from FMLA leave. This certification is being sought only with regard to the particular health condition that caused the employees need for FMLA leave.

What does a fit-for-duty physical consist of?

The fit-for-duty test is a measurement of an applicants ability to perform workplace tasks in a safe manner. It includes testing aerobic ability, upper and lower body strength, and body mechanics.

What is involved in a fit for work test?

A fit-for-duty exam determines if the employee is physically and/or psychologically able to safely perform their current role. These specialized exams are typically reserved for more labor-intensive roles, and the exams are unique to each employer and their positions.

Fitness For Duty Certificate - fcps 2026

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