Work Release Form

Sometimes, we all face days when we cannot go to work due to reasons tied to our physical condition or health problems. A work release form is the type of release of liability form that people in the United States may submit to skip work legally when they feel ill.

Medical care representatives are the ones who create this paper, not the patient. Typically, each work release form contains:

  • The day when the patient (or employee) may get back to work
  • Restrictions for the employee’s activities and duties
  • Terms in which these restrictions are effective
  • The signature of the doctor.

When to Use Work Release

One should submit a work release form (or doctor release form) when they have a sickness that makes it impossible to work and attend the workplace.

Another case is when a person is allowed to attend the workplace, but to do limited duties. For example, suppose the work is tied to carrying heavy items, and a worker has back pain and confirmed diagnosis. In that case, their physician will probably prohibit the person from lifting and carrying heavy items.

Creation of a Work Release Form: General Steps

  • Notify the Employer. If you feel sick, you should tell your employer that you need to take the day off due to health reasons.
  • Go to Your Physician. As we have mentioned before, a doctor created a work release form, not an employee. To get the form, you should go to the physician who defines what is happening to you and how long you will be absent from work.
  • Pass the Notice to the Employer. After you have been diagnosed and issued the form, submit the document to your employer.
Template Preview
Download your fillable Work Release template in PDF.

Filling Out a Work Release Form

Obtain the Template

The completion of almost every legal paper in the US begins with downloading the template. Use our form-building software to obtain the relevant file quickly. Do not forget to bring the form to your doctor.

Add the Patient’s (Employee’s) Name

The first blank lines you see in the document are dedicated to the patient’s (“employee’s”) details. Write the name and the date.
Step 2 to filling out a work release form - patient name

Decide When the Patient May Get Back to Work

The doctor should insert the date of the patient’s return to work.
Step 3 to filling out a work release template - return date

Define the Restrictions (If Any)

The doctor has to define if there are any restrictions applicable to the patient’s duties. For example, if the patient cannot lift heavy items or work while standing, the doctor should detail those facts here.

After choosing the restrictions, the doctor should add the last day when they will be effective.
Step 4 to filling out a work release sample - restrictions

Sign the Work Release Form

The physician, not the patient, signs the work release form. They should append their signature and additional notes (if there are any notes to leave).
Step 5 to filling out a blank work release form - signature

Published: Jan 18, 2021