Fitness For Duty Certificate - fcps 2026

1. Click ‘Get Form’ to open the Fitness For Duty Certificate in the editor.
2. 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.
3. Fill in your personal details, including your name, Employee ID (not SSN), position, and contact numbers. Ensure accuracy for seamless communication.
4. Authorize your health care provider by signing and dating the designated section. This allows them to share necessary information regarding your return to work.
5. 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.
6. Complete any cognitive or physical limitations sections as instructed by your physician. Be specific about any restrictions or required accommodations.
7. Finally, have your attending physician sign and date the form, ensuring all fields are filled out correctly before submission.

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