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Get and Sign Return to Work Plan Template  Form

Get and Sign Return to Work Plan Template Form

Use a return to work plan template 0 template to make your document workflow more streamlined.

Work: Actual Return to Work without restrictions: Return to work with reduced schedule: Number of hours per day: Number of days per week: Beginning: Ending: Return to work with the following restrictions: Lifting (weight) 0-10 lbs. Beginning: 11-25 lbs. Ending: 26-40 lbs. 41-50 lbs. over 50 lbs. Lifting From Floor 25% 50% 75% 100% From waist level 25% 50% 75% 100% Over the shoulder/head Pushing/pulling (weight) Pushing/pulling frequency 25% 50% 75% 100% 0-10 lbs. 11-25...
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