Light duty work restrictions form: free download. On-line document store on 5y1.org

[DOC File]Human Resources | Oklahoma State University
https://info.5y1.org/light-duty-work-restrictions-form_1_b66120.html
Review the physician’s restrictions with the employee prior to or upon his/her return to work. Discussions may include University Human Resources, the employee and the department/supervisor. Provide work that falls within the work restrictions provided by the physician. Provide a safe work …
light duty template for doctor

[DOC File]Event Sign In Sheet template - Saif
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Release to Return-to-Work. form and . Job Description Form, the form(s) must be returned to Personnel within 24 hours for assignment of light duty/modified work. The worker must report for work at the designated time. The . worker cannot return to work …
light duty letter sample

[DOCX File]Rogers State University
https://info.5y1.org/light-duty-work-restrictions-form_1_52a93a.html
Full Duty Release without Temporary restrictions: employee is able to work full duty without restrictions, but is not released from active medical care. _____ Light Duty Release with Temporary Restrictions: employee has NOT reached (MMI) and can return to Light Duty Work with the following temporary restrictions: (COMPLETE RESTRICTIONS …
offer of light duty form

fitness for duty - Human Resources
Indicate the exact work restrictions which apply to the employee at this time on the chart on the back of this form. (Complete this section if the employee is being released to modified duty.) PHYSICAL EXAMINATIONS FULL. RESTRICTIONS PARTIAL. RESTRICTIONS NO. RESTRICTIONS Sedentary-Lifting 0 to 10 pounds Light …
light duty restriction form template

[DOC File]WORKERS' COMPENSATION: MODIFIED-LIGHT DUTY …
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These work duties are offered to you as of_____and will be re-evaluated on _____if you have not been released to full duty. We are offering you this position to accommodate the medical restrictions identified by your physician. You must follow your abilities and restrictions …
light duty forms template

[DOC File]Labor & Industries (L&I), Washington State
https://info.5y1.org/light-duty-work-restrictions-form_1_a78478.html
Base wage for light-duty or transitional work-rate: $ per (See page 2 for more on base wages.) Total # of days requested (employee actually worked light duty) Total base wage paid this period for light duty or transitional work: $ 50% amount you’re requesting: $ Hints: Enter dates, # of hours, and . total daily wage. paid for each day’s work.
light duty restrictions letter

Light duty work restrictions form