Work release forms are issued by medical offices or health centers to establish that an individual is fit to work or to go back to work. Any restriction with regards to his/her health will be stated in the form.

If you are on the lookout for Sample Forms you can use for work release, you’re in great luck! We have nine samples that you can use as a reference for drafting your very own work release form. These forms come in various outlines and designs giving you a wide assortment of choices. Check out all of the samples that we have for you and choose the one that you want to use as reference.

Medical Work Release Form Sample

medical work release form sample

everettclinic.com

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  • PDF

Size: 181 KB

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Return to Work Release Form in PDF

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  • PDF

Size: 62 KB

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Player Medical Work Release Form Sample

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  • PDF

Size: 320 KB

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Minor Work Release Form in PDF

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  • PDF

Size: 325 KB

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Student Work Release Form Example

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  • PDF

Size: 89 KB

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What Is a Work Release Form?

Ensuring that employees in a company are in tip-top shape before they start coming back to work or before they are allowed to start their work, a physical exam must be done to ensure proper health condition is observed. A work release form is usually used to establish that an employee has recovered from an illness or that an applicant is deemed to be in good health and is fit to work. Any limitations that the patient may have should be duly stipulated in the form so that the employer will be aware of these. For regular employees, this form is highly important to ensure that the employee will be paid a sick leave.

You are free to browse more work release forms in our Sample Work Release Forms.

Who Makes Use of Work Release Forms?

Work release forms are usually filled out by a physician and are issued to a patient who has either missed some working days or is asked to have a physical checkup for employment as part of the employment requirements. These forms should be clearly communicated so ensuring that all the details about the health of the patient should be stated.

There are other types of release form. One of them is a Talent Release Form.

School Work Release Form Sample

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  • PDF

Size: 18 KB

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Free Printable Work Release Form

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  • PDF

Size: 145 KB

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Work for Hire Agreement Form in PDF

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  • Doc

Size: 71 KB

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Blank Work Release Form Sample

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  • PDF

Size: 225 KB

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Construction Work Release Form in PDF

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  • PDF

Size: 66 KB

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Accompaniments and Attachments

One may ask if there is a need to attach other forms to a work release form. It is not necessarily a requirement but it will be great to let the doctor know your job title and description. This will enable the doctor make a thorough and competent assessment of the patient’s current situation.

Once the work release form has been completely filled out, it is not necessary to provide any additional attachments or documents unless otherwise stated by the authorized parties or if company policy states that there is a need for you to provide any.

When to Submit

A work release form should be submitted to an HR officer or immediate supervisor as soon as the employee has been declared to be fit for work or ready to return to work.

Typical Format

A work release form will usually have the following fields:

  • Employee details such as name, contact number, and job title
  • Physician details such as complete name, contact number, and license number
  • Date of patient’s visit
  • Current condition such as ability to work
  • Limitations and restrictions

 

A physician should also sign the form as an attestation that all the details presented in the form are true and correct.

You may also be interested in checking out Media Release Forms.

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