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Employee Medical Report

Seneca College aims to facilitate a safe and early return to work for employees recovering from illness or injury, providing accommodations as necessary. A return-to-work plan will be developed by the College's Return-to-Work Specialist in collaboration with the employee and relevant parties. The document includes sections for health professionals to complete regarding the employee's condition and return-to-work status.

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56 views2 pages

Employee Medical Report

Seneca College aims to facilitate a safe and early return to work for employees recovering from illness or injury, providing accommodations as necessary. A return-to-work plan will be developed by the College's Return-to-Work Specialist in collaboration with the employee and relevant parties. The document includes sections for health professionals to complete regarding the employee's condition and return-to-work status.

Uploaded by

akhil.decoder
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd

EMPLOYEE MEDICAL REPORT

Seneca College is committed to establishing safe and early return to work opportunities for
employees recovering from injury or illness. The College will support returning employees
and every reasonable effort will be made to accommodate those who are unable to perform
their regular duties as a result of illness, injury, diminished capacity, or disability. With the
information provided by the health professional, the College’s Return-to-Work Specialist
will develop an appropriate return to work plan, with the aid and cooperation of the
employee, union representative (if applicable) and supervisor.

Please note the following two pages (applicable sections) must be completed by the treating
health professional:

Employee’s Name: Date of Assessment:


Health Professional’s Name (please print):
Address (please print):
Phone Number: __________________________________ Fax Number: _________________________________

General Nature of illness/injury resulting in absence/accommodation:

_________________________________________________________________________________________

Employee has been absent/accommodated since: ___________________________________________

Please complete all that apply:

RETURN TO WORK
Employee may immediately return to full duties and has no physical or functional
limitations.

☐ Yes ☐ No

Date of return: _____________________ If no, see following applicable question(s)

CONTINUED ABSENCE
Employee requires an extended absence from work and will be reassessed on:
____________________
Anticipated date of return to work: ____________________

OR

GRADUAL RETURN TO WORK/ACCOMMODATION PROGRAM


Employee can participate in a gradual return to work/accommodation program. Please
state appropriate time frames. (Important - indicate the employee’s physical restrictions
and/or functional limitations on the next page)

•
•
•

Have you recommended a course of treatment to assist the patient to resume full time
status? ☐ Yes ☐ No

Is the employee participating in the treatment to assist him/her to resume full time status?
☐ Yes ☐ No

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