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FOR HUMAN RESOURCES USE ONLY: Employee Classification (select one): A M P Database Entry Return Confirmation Letter Mainframe Entry RETURN TO WORK REQUEST Directions: Type or print the required information.
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How to fill out return to work request

How to fill out a return to work request:
01
Obtain the necessary form: Start by checking if your organization has a specific form for requesting a return to work. If they do, obtain a copy of the form either from your supervisor or the human resources department.
02
Fill out personal information: Begin by providing your personal details such as your name, employee ID number, contact information, and job title. Make sure to double-check the accuracy of the information before moving forward.
03
Specify the reason for the request: Clearly state the reason for your return to work request. Whether it is due to recovering from an illness, injury, or any other specific circumstance, it is crucial to provide a detailed explanation to assist your employer in assessing your request.
04
Include supporting documentation: Depending on the situation, you might need to attach supporting documentation to the return to work request form. This may include medical certificates, doctor's notes, or any other relevant documentation that validates your need for a return to work.
05
Outline any work restrictions or accommodations: If your medical condition requires any specific work restrictions or accommodations, ensure that you clearly mention them in the request form. This will enable your employer to make the necessary arrangements to support your safe and successful return.
06
Date and sign the form: Once you have completed the form and reviewed all the information, sign and date it to indicate your consent and agreement with the provided details. Keep a copy of the form for your records.
Who needs a return to work request:
01
Employees returning from a medical leave of absence: Individuals who have been on a medical leave of absence, whether due to an illness, injury, or surgery, typically need to submit a return to work request to inform their employer of their readiness to return.
02
Workers recovering from a work-related injury: In cases where an employee has experienced a work-related injury and is now ready to resume their duties, a return to work request is often required to ensure a smooth transition back into the workforce.
03
Individuals requesting work accommodations: If an employee requires work accommodations or modifications due to a disability or long-term health condition, they may need to submit a return to work request to outline their needs and provide supporting documentation.
Remember, the specific requirements for a return to work request may vary between organizations and jurisdictions. It is important to consult your employer's policies or seek guidance from your human resources department for accurate instructions tailored to your situation.
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