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Get Collin College Fitness for Duty/Return to Work Form

Fitness for Duty/Return to Work Form Medical authorization from attending physician is required for employees returning to work from family and medical leave. This form must be returned to the Human Resources prior to or before returning to work. Employee Section Employee Name/Patient Last First Date of Injury/Illness CWID Physician Section May resume work immediately with no restrictions Sedentary work sitting occasional walking standing lifting less than 10 lbs. Light work lifting less than 20 lbs. Medium work lifting less than 50 lbs. Heavy work lifting less than 100 lbs. He/She is released to work Hours per day His/Her normal shift He/She may return to work at full duty on date He/She has a return appointment on date and time at time Physician Signature Physician Name print Date Phone Number include area code Street Address City State and Zip Code Collin College Human Resources Department Collin Higher Education Center 3452 Spur 399 McKinney Tx 75069 Fax 972-985-3778. This form must be returned to the Human Resources prior to or before returning to work. Employee Section Employee Name/Patient Last First Date of Injury/Illness CWID Physician Section May resume work immediately with no restrictions Sedentary work sitting occasional walking standing lifting less than 10 lbs. Light work lifting less than 20 lbs. Medium work lifting less than 50 lbs. Heavy work lifting less than 100 lbs. This form must be returned to the Human Resources prior to or before returning to work. Employee Section Employee Name/Patient Last First Date of Injury/Illness CWID Physician Section May resume work immediately with no restrictions Sedentary work sitting occasional walking standing lifting less than 10 lbs. Light work lifting less than 20 lbs. Medium work lifting less than 50 lbs. Heavy work lifting less than 100 lbs. .

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