Purpose: This policy establishes a framework for Fitness-for-Duty (FFD) examinations for employees returning to work after a significant illness, injury, leave of absence, or any situation where concerns arise about their ability to perform their job duties safely and effectively. By implementing this policy, we aim to: Scope: This policy

Employee Information: Reason for Examination: Examination Components: Fitness for Duty: Additional Recommendations: Confidentiality: All information obtained during this examination is considered confidential and will be disclosed only with the employee’s written consent, except as required by law. Examiner Signature: Date: Disclaimer: This is a sample form and may not be