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Return To Work Authorization Form

Return To Work Authorization Form Template for Philippines

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Key Requirements PROMPT example:

Return To Work Authorization Form

"I need a Return to Work Authorization Form for a manufacturing company employee returning from a major surgery, with provisions for gradual return to physical duties starting March 15, 2025, including specific lifting restrictions and modified work hours for the first month."

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Document background
The Return To Work Authorization Form is a standard document used in Philippine workplaces when employees need to resume work following an absence due to medical reasons. This document is essential for compliance with Philippine labor laws, particularly the Labor Code and Republic Act No. 11058 on Occupational Safety and Health Standards. It becomes necessary when an employee has been absent due to illness, injury, medical procedure, or other health-related circumstances, including COVID-19 related absences. The form typically includes medical clearance from a licensed healthcare provider, details of any work restrictions or accommodations, and necessary authorizations from relevant parties. It serves both as a protective measure for the employer and as a guarantee of the employee's right to return to work under safe conditions.
Suggested Sections

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

2. Absence Information: Details of the absence period, reason for absence, and last day worked

3. Medical Clearance: Confirmation from healthcare provider that employee is fit to return to work

4. Return to Work Details: Specified return date and any relevant work schedule information

5. Health and Safety Declaration: Employee's declaration regarding current health status and ability to perform job duties

6. Authorization Signatures: Signature blocks for employee, healthcare provider, and authorized company representative

Optional Sections

1. Work Restrictions/Accommodations: Used when employee requires specific accommodations or has temporary/permanent work restrictions

2. COVID-19 Declaration: Required when return to work is following a COVID-19 related absence

3. Gradual Return Plan: Include when employee needs a phased return to full duties

4. Follow-up Requirements: Specify when ongoing medical monitoring or follow-up assessments are needed

5. Risk Assessment: Include when returning from specific health conditions that may affect workplace safety

Suggested Schedules

1. Medical Certificate: Official medical certification from healthcare provider confirming fitness to return

2. Workplace Accommodation Plan: Detailed plan of any required workplace modifications or restrictions

3. Employee Acknowledgment Form: Separate form for employee to acknowledge understanding of return conditions

4. Health Monitoring Schedule: Timeline for any required follow-up health checks or assessments

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

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alex.den.21@genieai.co
Relevant legal definitions
Authorized Medical Provider
Company
Employer
Employee
Return to Work Date
Medical Clearance
Work Restrictions
Essential Job Functions
Reasonable Accommodation
Fitness for Duty
Medical Leave
Regular Duties
Modified Duties
Occupational Health and Safety Standards
Healthcare Declaration
Work Capacity
Gradual Return Plan
Medical Certification
Workplace Accommodation
Department Supervisor
Human Resources Representative
Safety Officer
Regular Working Hours
Medical Documentation
Relevant Industries

Manufacturing

Construction

Healthcare

Information Technology

Financial Services

Retail

Education

Mining

Agriculture

Transportation

Hospitality

Business Process Outsourcing

Government Services

Telecommunications

Relevant Teams

Human Resources

Legal

Occupational Health and Safety

Compliance

Operations

Medical Services

Risk Management

Employee Relations

Administration

Relevant Roles

HR Director

HR Manager

Occupational Health and Safety Manager

Medical Officer

Compliance Officer

Legal Counsel

Department Manager

Supervisor

Employee Relations Manager

Risk Management Officer

Operations Manager

Facility Manager

Industries
Labor Code of the Philippines (Presidential Decree No. 442): The primary labor law that governs employment relationships and sets basic standards for employment conditions, including provisions for sick leave and return to work procedures
Republic Act No. 11058: An Act Strengthening Compliance with Occupational Safety and Health Standards (OSHS), which ensures that employees returning to work meet safety and health requirements
Data Privacy Act of 2012 (Republic Act No. 10173): Regulates the collection, handling, and protection of personal information, including medical information in return-to-work documentation
Republic Act No. 11058 Implementing Rules and Regulations: Detailed guidelines on implementing occupational safety and health standards, including requirements for medical clearances and fitness for work certifications
DOLE Department Order No. 198-18: Implementing Rules and Regulations of the OSHS Law, which includes specific provisions on medical examinations and return-to-work policies
DOLE-DOH Joint Memorandum Circular No. 20-04-A: Guidelines on COVID-19 prevention and control at the workplace, including return-to-work protocols during the pandemic
Civil Service Commission Memorandum Circular No. 2, s. 2022: Updated guidelines on absences of government officials and employees due to quarantine and/or treatment relative to COVID-19, including return-to-work procedures
Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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