Get the free Fitness for Work Form - University of Calgary - ucalgary

Fitness for Work Form For absences greater than 10 days Send completed form to confidential fax 403-282-8603 Staff Wellness TO BE COMPLETED BY EMPLOYEE Name: ID#: Job position: Work location: Home

How to fill out fitness for work form

How to fill out fitness for work form:

1. Obtain the form: Contact your employer or human resources department to obtain the fitness for work form. It may be provided to you electronically or in paper format.
2. Read the instructions: Carefully read the instructions provided with the form. These instructions will guide you on how to fill out the form accurately and completely.
3. Personal information: Start by entering your personal information on the form. This usually includes your name, employee ID number, contact details, and job title.
4. Dates: Indicate the dates relevant to the fitness for work form. This may include the date of your illness or injury, the date you are submitting the form, and any relevant dates related to your absence from work.
5. Medical information: Fill in the details about your medical condition or injury that caused you to be absent from work. Include relevant information such as the nature of the illness or injury, any symptoms experienced, and any treatments or medications you have received.
6. Healthcare provider details: Provide the contact information of the healthcare provider who has been treating you. This may include their name, clinic or hospital, contact number, and any other relevant details.
7. Return to work plan: If you have a return to work plan recommended by your healthcare provider, include the details on the form. This may include any restrictions or accommodations that need to be made for your return to work.
8. Signature: Once you have completed the form, sign and date it to affirm the accuracy of the information provided.

Who needs fitness for work form:

1. Employees returning from illness or injury: Employees who have been absent from work due to illness or injury may be required to fill out a fitness for work form. This form helps the employer assess whether the employee is fit to return to work and if any accommodations need to be made.
2. Employees with prolonged absence: If an employee has been absent for an extended period, the employer may request a fitness for work form to ensure that the employee is physically and mentally fit to resume their duties.
3. Individuals with a disability or health condition: Employees with a disability or ongoing health condition may be asked to provide a fitness for work form periodically to assess their ability to perform their job duties and determine if any accommodations are needed.

Remember, it is important to follow your employer's specific guidelines and procedures when filling out the fitness for work form. If you have any doubts or questions, it is recommended to consult your employer or human resources department for assistance.

For pdfFiller’s FAQs

What is fitness for work form?

Fitness for work form is a document that assesses an individual's physical and mental ability to perform their job duties.

Who is required to file fitness for work form?

Employees or individuals who are returning to work after a medical leave or illness are required to file fitness for work form.

How to fill out fitness for work form?

Fitness for work form can be filled out by the employee's healthcare provider or physician, detailing the individual's capabilities and any restrictions.

What is the purpose of fitness for work form?

The purpose of fitness for work form is to ensure that employees are medically fit to safely perform their job responsibilities.

What information must be reported on fitness for work form?

The fitness for work form typically includes information on the individual's medical history, current physical and mental condition, any limitations or restrictions, and recommendations for accommodations if needed.

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