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PENNSYLVANIA DEPARTMENT OF HEALTH 2022 PAGAN 662 930UPD UPDATE: Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 DATE: TO: FROM: SUBJECT: DISTRIBUTION:9/30/2022 Health

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How to fill out return to work for

01

Obtain the return to work form from your employer.

02

Fill out your personal information such as name, address, and contact information.

03

Provide details about your medical condition or reason for needing the return to work form.

04

Include any relevant dates such as when you were first seen by a doctor and when you are cleared to return to work.

05

Sign and date the form before submitting it to your employer.

Who needs return to work for?

01

Individuals who have been on medical leave or disability and are now cleared to return to work.

02

Individuals who have been injured on the job and need to provide documentation before returning to work.

03

Employees who have taken a leave of absence and need approval from their employer to return to work.

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What is return to work for?

Return to work is for employees who are returning to work after a period of absence.

Who is required to file return to work for?

Employers are required to file return to work for employees returning to work after a period of absence.

How to fill out return to work for?

Return to work forms can be filled out online or on paper, providing information about the employee's return to work plans.

What is the purpose of return to work for?

The purpose of return to work is to ensure a smooth transition for employees returning to work after an absence.

What information must be reported on return to work for?

Information such as the date of return, any modified duties or accommodations needed, and anticipated work schedule must be reported on return to work forms.

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