Common use of Return to Work Clause in Contracts

Return to Work. can return to work on to carry out normal duties Employee’s Name (Date) Without restrictions OR With the following restriction(s) and duration (if applicable): Physician’s/Nurse Practitioner’s/Midwife’s signature:

Return to Work. can return to work on _to carry out normal duties Employee’s Name (Date) Without restrictions OR With the following restriction(s) and duration (if applicable): Physician’s/Nurse Practitioner’s/MidwifePractitioner’s signature:

Return to Work. can return to work on to carry out normal duties Employee’s Name (Date) Without restrictions OR With the following restriction(s) and duration (if applicable): Physician’s/Nurse Practitioner’s/MidwifePractitioner’s signature:

Return to Work. can return to work on to carry out normal duties Employee’s Name (Date) Without restrictions OR With the following restriction(s) and duration (if applicable): Physician’s/Nurse Practitioner’s/Midwife’s signature: Date: SCHEDULE C MEDICAL CERTIFICATE OF READINESS TO RETURN TO WORK FOLLOWING PERSONAL ILLNESS OR INJURY PHYSICIAN INFORMATION NAME:

Return to Work. _can return to work on _ to carry out normal duties Employee’s Name (Date) Without restrictions OR With the following restriction(s) and duration (if applicable): Physician’s/Nurse Practitioner’s/Midwife’s signature: Date: SCHEDULE C MEDICAL CERTIFICATE OF READINESS TO RETURN TO WORK FOLLOWING PERSONAL ILLNESS OR INJURY PHYSICIAN INFORMATION NAME:

Return to Work. can return to work on to carry out normal duties Employee’s Name (Date) Without restrictions OR With the following restriction(s) and duration (if applicable): Physician’s/Nurse Practitioner’s/Midwife’s signature:):

Return to Work. can return to work on to carry out normal duties (Employee’s Name Name) (Date) duties. Without restrictions OR With the following restriction(s) and duration (if applicable): Physician’s/Nurse Practitioner’s/Midwife’s signature:

Return to Work. can return to work on to carry out normal duties Employee’s Name (Date) Without restrictions OR With the following restriction(s) and duration (if applicable): Physician’s/Nurse Practitioner’s/Midwife’s signature:: Date: MISCELLANEOUS INSTRUCTIONS (2019 – 2021 ROUND) Chartwell Xxxxx

Return to Work. can return to work on to carry out normal duties Employee’s Name (Date) Without restrictions OR With the following restriction(s) and duration (if applicable): Physician’s/Nurse Practitioner’s/Midwife’s signature: Date:

Return to Work. can return to work on to carry out normal duties Employee’s Name (Date) Without restrictions OR With the following restriction(s) and duration (if applicable): Physician’s/Nurse Practitioner’s/Midwife’s signature: Date: SCHEDULE C MEDICAL CERTIFICATE OF READINESS TO RETURN TO WORK FOLLOWING PERSONAL ILLNESS OR INJURY‌ PHYSICIAN INFORMATION NAME:

Return to Work. can return to work on to carry out normal duties Employee’s Name (Date) Without restrictions applicable): OR With the following restriction(s) and duration (if applicable): Physician’s/Nurse Practitioner’s/MidwifePractitioner’s signature:

Return to Work. can return to work on to carry out normal duties Employee’s Name (Date) Without restrictions OR With with the following restriction(s) and duration (if applicable): Physician’s/Nurse Practitioner’s/Midwife’s signature:

Return to Work. can Can return to work on to carry out normal duties Employee’s Name (Date) Without restrictions OR With the following restriction(s) and duration (if applicable): Physician’s/Nurse Practitioner’s/Midwife’s signature:

Return to Work. can return to work on to carry out normal duties (Employee’s Name Name) (Date) Without restrictions OR With the following restriction(s) and duration (if applicable): Physician’s/Nurse Practitioner’s/MidwifePractitioner’s signature:

Return to Work. can return to work on to carry out normal duties Employee’s Name (Date) Without restrictions OR With the following restriction(s) and duration (if applicable): Physician’s/Nurse Practitioner’s/MidwifePractitioner’s signature: Date:

Return to Work. can return to work on _to carry out normal duties Employee’s Name (Date) Without restrictions OR With the following restriction(s) and duration (if applicable): Physician’s/Nurse Practitioner’s/MidwifePractitioner’s signature: Date: