Request for Fitness for Duty or Return-to-Work Evaluation. The Ohio State University Office of Human Resources Policy 4.40 Request for Fitness for Duty or Return-to-Work Evaluation form. - hr osu 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. In Section 1, enter the employee's full name, OSU Employee ID#, title, department, supervisor’s name, office phone, HR representative’s name, and email address.
  3. Move to Section 2. Describe objective indications of physical and mental inability to perform essential job functions. Include observed behaviors and their impact on work duties.
  4. Address any safety concerns in Section 2. Indicate if the individual poses a threat to self or others and provide details if applicable.
  5. Complete Section 3 by checking off the checklist items that have been completed by the HR professional before scheduling an evaluation.
  6. Ensure all necessary attachments are included, such as current position descriptions and any medical documentation.
  7. Finally, have the unit human resource professional sign Section 4 and provide their contact information before submitting the form.

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