Work Release Form

work release form

Sometimes, we all face days when we cannot go to work due to reasons tied to our physical condition or health problems. A work release form is the type of release of liability form that people in the United States may submit to skip work legally when they feel ill.

Medical care representatives are the ones who create this paper, not the patient. Typically, each work release form contains:

When to Use Work Release

One should submit a work release form (or doctor release form) when they have a sickness that makes it impossible to work and attend the workplace.

Another case is when a person is allowed to attend the workplace, but to do limited duties. For example, suppose the work is tied to carrying heavy items, and a worker has back pain and confirmed diagnosis. In that case, their physician will probably prohibit the person from lifting and carrying heavy items.

Work Release Form Details

Document Name Work Release Form
Other Names Doctor Release, Medical Release to Return to Work
Avg. Time to Fill Out 18 minutes
# of Fillable Fields 99
Available Formats Adobe PDF

Creation of a Work Release Form: General Steps

Filling Out a Work Release Form

Obtain the Template

The completion of almost every legal paper in the US begins with downloading the template. Use our form-building software to obtain the relevant file quickly. Do not forget to bring the form to your doctor.

Add the Patient’s (Employee’s) Name

<a href=Step 2 to filling out a work release form patient name" width="830" height="146" />

The first blank lines you see in the document are dedicated to the patient’s (“employee’s”) details. Write the name and the date.

Decide When the Patient May Get Back to Work

Step 3 to filling out a work release template return date

The doctor should insert the date of the patient’s return to work.

Define the Restrictions (If Any)

The doctor has to define if there are any restrictions applicable to the patient’s duties. For example, if the patient cannot lift heavy items or work while standing, the doctor should detail those facts here.

Step 4 to filling out a work release sample restrictions

After choosing the restrictions, the doctor should add the last day when they will be effective.

Sign the Work Release Form

Step 5 to filling out a blank work release form signature

The physician, not the patient, signs the work release form. They should append their signature and additional notes (if there are any notes to leave).