Duty slip format 2025

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The document is a Fitness-for-Duty Certification form required for employees returning from FMLA leave due to a serious health condition. It includes sections for the employee's information, details about their health condition, dates of leave, and a statement from the treating health care provider confirming the employee's ability to perform job functions with or without accommodations. The form emphasizes confidentiality and compliance with the Americans with Disabilities Act.

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Click ‘Get Form’ to open the duty slip format in the editor.
Begin by entering the employee's name and position in the designated fields. This information is crucial for identifying the individual associated with the FMLA leave.
Fill in the building where the employee works, ensuring accurate details for proper documentation.
Describe the serious health condition that necessitated FMLA leave. Be as detailed as possible to provide context for the leave.
Input the start and end dates of the FMLA leave. This helps track the duration of absence.
Enter the name of the treating health care provider along with their field of specialization, if applicable.
Indicate whether the employee can perform essential job functions with or without reasonable accommodation by selecting 'Yes' or 'No'.
If there are any necessary restrictions or accommodations, detail them in the provided space to ensure a smooth return to work.
Finally, have the health care provider sign and date the form to validate it before submission.

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