Work Release Form Template

A work release form is a document signed by a medical professional that authorizes an employee to return to work after a period of leave due to illness, injury, or surgery. It specifies any restrictions on duties, hours, or physical activity that apply during the return period.

Returning an employee to work without documentation of their medical clearance creates liability for the organization and risk for the employee. A work release form creates a clear record of what was authorized, when, and under what conditions.

A complete work release form covers the employee's status and the medical professional's assessment. Consider including:

• Employee's full name and job title
• Date of leave and return to work date
• Medical professional's name, credentials, and contact details
• Full or modified duty clearance
• Specific restrictions (lifting, standing, hours, etc.)
• Expected duration of restrictions and follow-up date

Typically, the employee's treating physician or medical provider completes the clinical portion of the form, while the employee and HR representative acknowledge receipt and agree to the documented conditions. Some organizations have the manager sign as well to confirm awareness of applicable restrictions.

A new work release form or modification should be submitted by the employee's medical provider reflecting the updated status. Keep each document on record with a clear date so there's a full timeline of the employee's return-to-work history.