Duty slip format 2026

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. Ensure accuracy as this information is crucial for identification.
Fill in the building where the employee works, followed by detailing the serious health condition that necessitated FMLA leave. Be concise yet thorough in your description.
Input the start and end dates of the FMLA leave. This helps track the duration of absence.
Provide 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 accommodations by selecting 'Yes' or 'No'.
If there are any necessary restrictions or accommodations for returning to work, list them clearly in the provided space.
Finally, ensure that a health care provider's signature and date are included at the bottom of the form before submission.

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Versions	Form popularity	Fillable & printable
2006	4.8 Satisfied (50 Votes)
2004	4.6 Satisfied (55 Votes)

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