Follow the steps to complete your request form online.

1. Click the ‘Get Form’ button to access the form and open it in your document editor.
2. In Section 1, begin by entering your employee's name in the designated field. Next, input your employee ID number and the name of your supervisor. Finally, indicate your department.
3. Proceed to the Healthcare Provider’s Statement portion. Here, the healthcare provider must certify your ability to return to work by filling in their name and the specific date of your return.
4. Inquire about any restrictions or limitations you might have upon returning to work. If applicable, select 'Yes' and provide a detailed description of the restrictions in the designated field. Additionally, specify the end date for these restrictions or note the date of your next follow-up appointment.
5. Next, the healthcare provider must print their name and phone number in the respective fields. They are also required to sign the form and include the date of signing.
6. Before finalizing, ensure that you review the entire form for completeness. Once verified, provide the completed form to your supervisor for their signature.
7. After obtaining the supervisor's signature, fax the document to HR at the provided secure fax number, 615-343-2176. It is also recommended to keep a copy of the returned form for your personal records.

Complete your Request To Return From Leave Of Absence online today for a smooth transition back to work.