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1. Patient Information: Employee's full name, ID number, and relevant contact details
2. Employer Information: Company name, department/division, and supervisor/HR contact details
3. Medical Leave Information: Period of medical leave, general nature of medical condition (within confidentiality limits), and dates of medical treatment
4. Medical Clearance Declaration: Formal statement by the medical practitioner confirming the employee is fit to return to work
5. Return to Work Date: Specific date when the employee is cleared to resume work duties
6. Medical Practitioner Information: Doctor's full name, practice number, contact details, and practice stamp
1. Work Restrictions: Specific limitations or restrictions on work activities, used when the employee requires temporary or permanent accommodations
2. Follow-up Requirements: Details of any required follow-up appointments or ongoing medical monitoring, included when continued medical supervision is necessary
3. Gradual Return Plan: Structured plan for phased return to full duties, used when a gradual return to work is medically recommended
4. COVID-19 Declaration: Additional declarations specific to COVID-19 clearance, required if the absence was related to COVID-19 or if mandated by current regulations
5. Workplace Accommodation Requirements: Specific workplace modifications or accommodations needed, included when the employee requires special arrangements
1. Physical Activity Restrictions Form: Detailed breakdown of specific physical activities the employee can/cannot perform
2. Workplace Accommodation Checklist: Checklist of required workplace modifications or special arrangements
3. Medication Schedule: If relevant, schedule of medication that needs to be taken during work hours
4. Follow-up Appointment Schedule: Calendar of required follow-up medical appointments and assessments
Employee
Employer
Fit for Duty
Return to Work Date
Medical Condition
Work Restrictions
Workplace Accommodations
Essential Job Functions
Modified Duties
Temporary Restrictions
Permanent Restrictions
Medical Leave
Occupational Health and Safety
Practice Number
Medical Certificate
Gradual Return Plan
Full Capacity
Limited Capacity
Follow-up Assessment
Medical Surveillance
Fitness Certificate
Work Capacity Evaluation
Regular Duties
Physical Requirements
Health and Safety Representative
Confidential Medical Information
Occupational Health Practitioner
Medical Review Officer
Risk Assessment
Confidentiality
Health and Safety
Workplace Accommodations
Return to Work Conditions
Medical Restrictions
Compliance
Work Capacity
Follow-up Requirements
Risk Management
Medical Information Protection
Duty Modifications
Occupational Health
Employee Obligations
Employer Obligations
Medical Practitioner Declarations
Duration and Validity
Privacy Protection
Healthcare
Manufacturing
Mining
Construction
Financial Services
Retail
Education
Technology
Transportation
Agriculture
Public Sector
Professional Services
Hospitality
Energy
Telecommunications
Human Resources
Occupational Health and Safety
Risk and Compliance
Employee Relations
Operations Management
Facilities Management
Legal
Employee Wellness
Medical Services
Industrial Relations
Human Resources Director
Health and Safety Manager
Occupational Health Nurse
HR Business Partner
Employee Relations Manager
Risk Manager
Compliance Officer
Department Manager
Site Supervisor
Operations Manager
Facilities Manager
Workforce Manager
Employee Wellness Coordinator
Return to Work Coordinator
Medical Review Officer
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