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Return To Work Claim Form

Return To Work Claim Form Template for Singapore

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Key Requirements PROMPT example:

Return To Work Claim Form

"I need a Return To Work Claim Form for an employee returning from a 3-month medical leave due to a workplace injury in our manufacturing facility, including provisions for light duties and gradual return starting March 2025."

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Document background
The Return To Work Claim Form is a critical document in Singapore's workplace safety and health framework. This form is required when an employee seeks to resume work following a work-related injury or illness, as maNDAted by Singapore's Work Injury Compensation Act. The form must be completed to document the transition back to work, including medical clearance, work capacity assessment, and any necessary workplace accommodations. It serves multiple purposes: ensuring legal compliance, facilitating insurance claims, protecting both employer and employee interests, and promoting safe return-to-work practices.
Suggested Sections

1. Employee Information: Personal details including name, NRIC/FIN, contact information, employment status, job title and department

2. Injury/Illness Details: Nature of injury/illness, date and time of occurrence, circumstances of incident, and location where incident occurred

3. Medical Information: Details of medical treatment received, attending physician information, hospital/clinic details, and medical certificates issued

4. Work Status Declaration: Current work capacity assessment, intended return date, and any work restrictions

5. Employee Declaration: Declaration of truth and accuracy of information provided, with employee signature and date

Optional Sections

1. Light Duties Request: Section for requesting modified duties when employee has partial work capacity as certified by medical professional

2. Workplace Accommodation: Details of special arrangements or modifications needed in the workplace to facilitate return to work

3. Third Party Claims: Information regarding any third party liability or related insurance claims

Suggested Schedules

1. Medical Certificates: Appendix containing copies of all relevant medical certificates and sick leave documentation

2. Treatment Records: Appendix containing supporting medical documentation, treatment records, and physician reports

3. Incident Reports: Appendix containing workplace accident reports and any related investigation findings

4. Return to Work Plan: Schedule outlining the detailed plan for gradual return to full duties, including timeline and milestones

Authors

Alex Denne

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

alex.den.21@genieai.co
Relevant legal definitions






























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Industries

Work Injury Compensation Act (WICA): Primary legislation governing work injury compensation, including qualifying injuries, compensation calculations, and claim time limits. Essential for structuring return-to-work claims and compensation elements.

Employment Act: Core employment legislation covering basic employment terms, leave entitlements, salary protection, and working hours regulations. Relevant for understanding employee rights during return-to-work process.

Workplace Safety and Health Act: Legislation focusing on workplace safety requirements, employer obligations, risk assessments, and safety considerations for returning workers. Critical for ensuring safe return-to-work conditions.

Personal Data Protection Act (PDPA): Data protection legislation governing the collection and use of personal information, including consent requirements and usage limitations for medical and personal data in claim forms.

Tripartite Guidelines on Fair Employment Practices: Guidelines establishing non-discrimination principles, fair treatment requirements, and accommodation guidelines for returning workers. Essential for ensuring fair treatment during return-to-work process.

Ministry of Manpower (MOM) Guidelines: Official guidelines covering return-to-work programs, light duties arrangements, medical leave management, and injury reporting requirements. Provides practical framework for return-to-work implementation.

Central Provident Fund Act: Legislation governing CPF contributions during medical leave, salary computations, and benefits coverage. Important for understanding financial implications during return-to-work period.

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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