Return To Work Medical Certification Form Template for Saudi Arabia

1. Work Restrictions: Detailed description of any temporary or permanent work restrictions, used when the employee requires workplace accommodations

2. Gradual Return Plan: Specific schedule and progression for gradual return to full duties, included when a phased return is recommended

3. Follow-up Requirements: Schedule of follow-up medical evaluations if needed, included when ongoing medical monitoring is required

4. Workplace Injury Details: Additional section for cases where the absence was due to a workplace injury, including incident reference numbers

5. COVID-19 Declaration: Special declaration regarding COVID-19 status and protocols, included during pandemic-related requirements

1. Schedule A - Physical Capacity Evaluation: Detailed assessment of physical capabilities and limitations, attached when specific physical restrictions exist

2. Schedule B - Workplace Accommodation Plan: Detailed plan for implementing workplace modifications or accommodations

3. Appendix 1 - Medical Privacy Consent: Employee's consent for sharing specific medical information with employer

4. Appendix 2 - Job Description: Detailed description of employee's regular job duties for healthcare provider reference