Return To Work Clearance Form

Return To Work Clearance Form Template for India

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Key Requirements PROMPT example:

"I need a Return to Work Clearance Form for an IT employee returning from a three-month medical leave due to surgery in March 2025, requiring remote work accommodations for the first month and gradual return to office setup."

Document background

The Return To Work Clearance Form is a crucial document in the Indian workplace context, designed to protect both employer and employee interests while ensuring compliance with national and state-level labor regulations. This document becomes necessary when employees return from extended absences due to illness, injury, maternity leave, or other significant breaks from work. It incorporates requirements from various Indian legislative frameworks, including the Factories Act 1948, the Occupational Safety, Health and Working Conditions Code 2020, and relevant state-specific regulations. The form includes medical clearances, work modification requirements, and health and safety declarations, serving as a formal record of the employee's fitness to resume duties and any necessary workplace accommodations.

Suggested Sections

1. Employee Information: Basic details including employee name, ID, department, designation, and contact information

2. Absence Details: Information about the reason for absence (illness/injury/maternity/other), duration of absence, and last working day

3. Medical Clearance: Medical practitioner's certification of fitness to return to work, including any specific health conditions or ongoing treatments

4. Work Modification Requirements: Details of any necessary workplace accommodations, modified duties, or gradual return to work plans

5. Health and Safety Declaration: Employee's declaration regarding current health status and agreement to follow safety protocols

6. Authorization: Signatures from employee, medical practitioner, HR representative, and immediate supervisor

Optional Sections

1. COVID-19 Status Declaration: Additional section for COVID-19 specific declarations and test results, required during active pandemic phases

2. Workplace Accommodation Plan: Detailed plan for modified duties or special arrangements, required when employee needs specific accommodations

3. Follow-up Schedule: Schedule of follow-up medical appointments or assessments, needed for cases requiring ongoing monitoring

4. Insurance Details: Section for ESI or other insurance-related information, required for cases involving insurance claims

5. Fitness Assessment Results: Detailed medical fitness test results, required for specific industries or roles with strict physical requirements

Suggested Schedules

1. Medical Certificate: Original medical certificate from treating physician or authorized medical practitioner

2. Risk Assessment Form: Evaluation of workplace risks relevant to the employee's condition

3. Medical Test Reports: Relevant medical test reports or fitness assessment results

4. Return to Work Plan: Detailed plan outlining gradual return or modified duties if applicable

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok��˰� | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Manufacturing

Information Technology

Healthcare

Construction

Financial Services

Retail

Education

Hospitality

Logistics

Mining

Telecommunications

Pharmaceutical

Automotive

Chemical Industry

Public Sector

Relevant Teams

Human Resources

Occupational Health and Safety

Legal

Compliance

Employee Relations

Risk Management

Medical Services

Operations

Administration

Relevant Roles

HR Manager

Occupational Health and Safety Officer

Compliance Manager

Employee Relations Manager

Medical Officer

Department Head

Line Manager

Shift Supervisor

HR Business Partner

Risk Management Officer

Health and Safety Coordinator

Return to Work Coordinator

Wellness Manager

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Physician's Return To Work Form

An Indian-compliant medical clearance form completed by physicians to certify an employee's fitness to return to work, including any necessary workplace accommodations or restrictions.

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Let's create your Return To Work Clearance Form

Authors

Alex Denne

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