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1. Employee Information: Essential details about the employee including full name, employee ID, department, and position
2. Employer Information: Company name, registration details, and relevant contact information
3. Absence Information: Details of the absence period, reason for absence (in general terms), and last day worked
4. Return to Work Details: Specified return date, work schedule, and any modified duties or accommodations
5. Medical Clearance Statement: General statement confirming medical fitness to return to work (specific medical details in schedule)
6. Employee Acknowledgment: Employee's confirmation of ability to perform duties and understanding of any restrictions
7. Signatures: Signature blocks for employee, employer representative, and medical practitioner
1. Workplace Accommodations: Detailed section for cases requiring specific workplace modifications or graduated return to work plans
2. Safety Protocols: Additional safety measures or protocols required for specific workplace conditions or health situations
3. Follow-up Requirements: Schedule of follow-up assessments or reviews, if needed for ongoing monitoring
4. Union Representative Acknowledgment: Additional signature section for unionized workplaces where union involvement is required
1. Schedule A - Medical Certification: Detailed medical clearance from healthcare provider including any specific restrictions or recommendations
2. Schedule B - Workplace Accommodation Plan: Detailed plan of any required workplace modifications or graduated return to work schedule
3. Schedule C - Health and Safety Assessment: Workplace safety assessment results and any required modifications for safe return
4. Appendix 1 - Employee Rights and Responsibilities: Document outlining the employee's rights and responsibilities during the return to work process
Manufacturing
Healthcare
Construction
Oil and Gas
Banking and Finance
Technology
Education
Retail
Mining
Transportation
Public Sector
Agriculture
Telecommunications
Professional Services
Human Resources
Occupational Health and Safety
Legal
Operations
Risk Management
Compliance
Employee Relations
Medical Services
Administration
HR Manager
HR Director
Occupational Health Nurse
Safety Manager
Employee Relations Manager
Benefits Administrator
HR Business Partner
Compliance Officer
Risk Manager
Department Manager
Line Supervisor
Operations Manager
Factory Manager
Site Supervisor
Medical Officer
Workplace Health Coordinator
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