Medical Certificate. Part 1 – Employee - please complete following: (Employee Name) The information supplied will be used in a confidential manner and may assist in creating a return to work plan. I hereby consent to the completion of this form by: Absent from Work (first date of absence) Not absent from work but requires accommodations (Treating Medical Practitioner’s Name) (Signature of Employee) (Date)
Appears in 5 contracts
Samples: Collective Agreement, Collective Agreement, Extension Agreement
Medical Certificate. Part 1 – Employee - please complete following: (Employee Name) The information supplied will be used in a confidential manner and may assist in creating a return to work plan. I hereby consent to the completion of this form by: 🞏 Absent from Work (first date of absence) 🞏 Not absent from work but requires accommodations (Treating Medical Practitioner’s Name) (Signature of Employee) (Date)
Appears in 3 contracts
Samples: Collective Agreement, Collective Agreement, Extension Agreement
Medical Certificate. Part 1 – Employee - please complete following: (Employee Name) The information supplied will be used in a confidential manner and may assist in creating a return to work plan. I hereby consent to the completion of this form by: Absent from Work (first date of absence) Not absent from work but requires accommodations (Treating Medical Practitioner’s Name) (Signature of Employee) (Date)
Appears in 1 contract
Samples: Collective Agreement
