Fitness for Duty Certification Form

The Fitness for Duty Certification Form is used by healthcare providers when determining how and when an employee may return to work after an injury. The completed form indicates to employers if an employee is fully released, released with restrictions, or not released to return to work. If the employee is released with restrictions, the Fitness for Duty Certification Form contains a section for healthcare providers to explain the specific restrictions, whether they be physical or behavioral in nature.