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1. Employee Information: Basic identification details including full name, employee ID, department, and position
2. Medical Leave Information: Details of the medical leave period, reason for leave (general category), and dates of absence
3. Healthcare Provider Certification: Medical professional's assessment and certification of fitness to return to work
4. Work Capacity Statement: Clear statement of employee's ability to return to work (full capacity/with restrictions)
5. Privacy Notice and Consent: Statement regarding the handling of medical information and employee's consent for sharing necessary details
6. Signatures and Dating: Spaces for signatures from healthcare provider, employee, and receiving employer representative
1. Workplace Accommodations: Section detailing any required workplace modifications or restrictions, used when employee requires temporary or permanent accommodations
2. COVID-19 Specific Declarations: Additional declarations specific to COVID-19 protocols, used when return to work is related to COVID-19 illness or exposure
3. Follow-up Requirements: Details of any required follow-up medical examinations or assessments, used when ongoing medical monitoring is necessary
4. Gradual Return to Work Plan: Schedule for phased return to full duties, used when employee requires graduated resumption of responsibilities
1. Medical Fitness Assessment Form: Detailed medical evaluation form to be completed by healthcare provider
2. Workplace Accommodation Checklist: List of specific workplace modifications or restrictions if applicable
3. Employee Health Monitoring Log: Template for tracking any required ongoing health monitoring
4. Return to Work Guidelines: Company-specific protocols and procedures for returning to work after medical leave
Healthcare
Manufacturing
Construction
Information Technology
Education
Retail
Financial Services
Transportation
Hospitality
Mining
Agriculture
Public Sector
Pharmaceuticals
Telecommunications
Energy
Human Resources
Occupational Health and Safety
Legal and Compliance
Risk Management
Employee Relations
Benefits Administration
Operations Management
Medical Services
Health and Wellness
HR Manager
HR Business Partner
Occupational Health Nurse
Safety Officer
Compliance Officer
Department Manager
Line Supervisor
Risk Management Officer
Employee Relations Manager
Benefits Administrator
Occupational Health and Safety Manager
Return-to-Work Coordinator
HR Operations Manager
Workplace Health Coordinator
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