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ORANGE TOWNSHIP PUBLIC SCHOOL DISTRICT Return to Work Certification Form For Staff Members with Suspected or Confirmed COVID-19 Related Illnesses In accordance with state and local laws and regulations,

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How to fill out return to work certification

01

Obtain the return to work certification form from your employer.

02

Fill in your personal information such as name, employee ID, and contact details.

03

Provide details about your medical condition or injury that necessitated time off work.

04

Include any restrictions or accommodations requested by your healthcare provider.

05

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

Who needs return to work certification?

01

Employees who have been on medical leave and are now returning to work.

02

Employees who have been injured on the job and are seeking clearance to resume work.

03

Employees with a medical condition that required time off work and now need authorization to return.

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What is return to work certification?

Return to work certification is a document that confirms an individual's ability to return to work after a period of absence due to illness or injury.

Who is required to file return to work certification?

Employees who have been on leave due to illness or injury are required to file return to work certification.

How to fill out return to work certification?

Return to work certification can be filled out by the employee's healthcare provider, stating that the employee is fit to return to work.

What is the purpose of return to work certification?

The purpose of return to work certification is to ensure that employees are medically cleared to resume work duties after a period of illness or injury.

What information must be reported on return to work certification?

Return to work certification must include the employee's name, date of examination, healthcare provider's signature, and confirmation of fitness to return to work.

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