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Get Work Release Form - The University Of Texas At San Antonio

Me First Name Middle Initial Normal Work Week is Shift Begin Time Division, Department or Office Hours per Day Shift End Time Title / Position Days per Week PHYSICIAN'S STATEMENT Before an employee may return to work, the return to work clearance process must be fully completed. Based on the employee's current medical examination and the job description, please complete the following: Max hours per day: Lift or carry maximum 0 2 4 6 8 Other pounds Bending/Stooping Walking Sitti.

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