Medical Leave Return To Work Form Template for Saudi Arabia

The Medical Leave Return To Work Form is a crucial document required under Saudi Arabian employment regulations when employees resume work following a medical absence. It serves multiple purposes: ensuring compliance with Saudi Labor Law and MHRSD regulations, documenting medical fitness for duty, protecting both employer and employee interests, and establishing any necessary workplace accommodations. This form is mandatory for all organizations operating in Saudi Arabia and must be completed before an employee can officially resume their duties after medical leave. It includes vital information such as medical clearance details, any work restrictions or accommodations, and required authorizations from medical practitioners, HR representatives, and supervisors. The document also supports compliance with GOSI requirements when applicable and helps organizations maintain proper records of employee medical leave returns.

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

2. Leave Details: Information about the medical leave period, including start and end dates, reason for leave (general category), and reference to original medical leave documentation

3. Medical Clearance: Confirmation from authorized medical practitioner that employee is fit to return to work, including date of medical examination and practitioner's details

4. Return to Work Status: Clear indication of whether return is full duty or with restrictions, including effective date of return

5. Acknowledgments: Declarations by employee regarding accuracy of information and understanding of return conditions

6. Authorization: Signature sections for employee, medical practitioner, HR representative, and immediate supervisor