Return To Work Certification Form Template for India

The Return To Work Certification Form is a critical document used in Indian workplace settings to manage and document an employee's return to work after an extended absence, whether due to medical conditions, personal circumstances, or other significant interruptions to regular work duties. This document is essential for compliance with Indian labor laws, including the Factories Act 1948, Shop and Establishment Acts, and various state-specific regulations. It includes vital information such as medical clearance, work capacity assessment, required accommodations, and safety protocols. The form serves multiple purposes: protecting both employer and employee interests, ensuring workplace safety compliance, documenting medical fitness, and establishing any necessary modifications to work arrangements. It's particularly relevant in post-illness scenarios, injury recovery, or when returning after extended leaves, helping organizations maintain proper documentation for legal and insurance purposes while ensuring a safe and appropriate return to work process.

1. Employee Information: Basic details including employee name, ID, department, designation, and contact information

2. Absence Details: Information about the period of absence, including start and end dates, and reason for absence (medical condition, quarantine, etc.)

3. Medical Certification: Details of medical clearance, including doctor's certification of fitness to return to work

4. Work Status Assessment: Evaluation of employee's ability to perform job duties, including any limitations or accommodations required

5. Health and Safety Declaration: Employee's declaration regarding current health status and compliance with safety protocols

6. Employer Assessment: Employer's evaluation of the return-to-work conditions and any necessary workplace accommodations

7. Authorization and Signatures: Signature sections for employee, medical professional, and authorized company representative