Return To Work Form From Doctor Template for Indonesia

The Return To Work Form From Doctor is a crucial document required under Indonesian labor law when employees resume work following a period of medical leave or absence. This form, mandated by Law No. 13 of 2003 on Manpower and supported by various health and safety regulations, serves as an official medical certification of an employee's fitness to return to their duties. It is designed to protect both employer and employee interests by clearly documenting medical clearance, any necessary workplace accommodations, and specific health-related restrictions. The form includes comprehensive medical assessments and recommendations, ensuring compliance with Indonesian workplace safety standards and healthcare regulations. It is particularly important in cases involving workplace injuries, extended illnesses, or conditions that may affect job performance, and may be required for BPJS healthcare documentation.

1. Employee Information: Basic details including employee name, ID number, position, department, and contact information

2. Medical Assessment Details: Date of examination, reason for leave (illness/injury), period of absence, and treating physician's information

3. Return to Work Status: Clear statement of whether employee is fit to return to work (full duties, modified duties, or not fit)

4. Work Capacity Evaluation: Assessment of employee's current capabilities and limitations in relation to job requirements

5. Medical Recommendations: Specific medical advice regarding work conditions, restrictions, or accommodations required

6. Duration and Follow-up: Timeframe for any restrictions, date for follow-up assessment if needed