An employer can require this work status form from an injured worker who has been off work or on transitional duties. It includes space for a doctor to sign.
Editable versions of all 1,721 forms from this site.
This Printable Business Form Template belongs to these categories: office
Subscribe to my free weekly newsletter — you'll be the first to know when I add new printable documents and templates to the FreePrintable.net network of sites.
Return to Work Form
Fields: Employer, name, ID #, injury date, exam, next exam, physical duties, transitional duty, full duty, physician certifies that patient can work (full duty, transitional duty, unable to work), physician certification (name, signature, facility address, facility phone, date).
People who printed this business form template also printed...
DISCLAIMER: The business forms and letters contained on BusinessFormTemplate.com are not to be considered as legal advice. All content is for informational purposes, and Savetz Publishing makes no claim as to accuracy, legality or suitability. The site owner shall not be held liable for any errors, omissions or for damages of any kind.
Subscribe to the Free Printable newsletter. (No spam, ever!)
This Printable Business Form Template is available to download for free, or you can download the entire collection for only $199.
The free version is available in your choice of DOC or PDF formats. The DOC version can be opened, edited, and printed using Word, Google Docs, etc. The PDF version can be opened and printed with any PDF viewer.
The $199 version includes all of the Printable Business Form Templates on this site, in DOC and PDF formats. After purchase, you can download them and use just a few business forms or the entire collection.
