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Attachment STATE OF HAWAII EXECUTIVE BRANCH
(Excluding DOE, HHSC, OHA, and UH)PHYSICIANS CERTIFICATION FORM
FOR
SAFETY TOE SHOES
Background information: The State of Hawaii Executive Branch Agencies,
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What is safety-toe shoe physicians certification?
Safety-toe shoe physicians certification is a document signed by a physician confirming that an individual requires safety-toe shoes for medical reasons.
Who is required to file safety-toe shoe physicians certification?
Individuals who need safety-toe shoes for medical reasons are required to file safety-toe shoe physicians certification.
How to fill out safety-toe shoe physicians certification?
To fill out safety-toe shoe physicians certification, individuals need to visit a physician who can assess their medical condition and confirm the need for safety-toe shoes.
What is the purpose of safety-toe shoe physicians certification?
The purpose of safety-toe shoe physicians certification is to ensure that individuals who need safety-toe shoes for medical reasons are provided with appropriate footwear in the workplace.
What information must be reported on safety-toe shoe physicians certification?
Safety-toe shoe physicians certification must include the individual's name, medical condition necessitating safety-toe shoes, physician's signature, and the date of certification.
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