Document Services

View Properties

Title:	RTW FORM.pdf
Summary:
Description:
Keywords:
Handle:	Document-33464
Owner:	Hanson, Jean (User-867, 07736:EVERETT)^DS
Create Date:	Monday, March 28, 2011 08:32:26 AM PDT
Modified Date:	Thursday, January 5, 2023 08:08:29 AM PST
Modified By:	Mulvaney, Linnea (User-5348, 14156:EVERETT)^DS
Expiration Date:
Locked By:
Abstract:	Name of Employee: Employee ID #: Released to return to work effective: Restrictions: YES NOIMPORTANT: Please complete the following items based on your clinical evaluation of the above captioned and other testing results. B. 6-10 lbs. C. 11-20 lbs. F. 51-100 lbs. 3. Employee can carry: Never Occasionally Frequently ContinuouslyA. Up to 5 lbs. D. 21-25 lbs.E. 26-50 lbs. YES NOComments:
Add Versions:	Allowed
Author:
Content Type:	Adobe Portable Document Format (.pdf) - application/pdf
File name:	RTW FORM 7.2022.pdf
Is Placeholder:	No
Max Versions:	4
Size:	146357
Copied From:
Last Synchronized:
Ready for Declare:	No
Appears In:	LEAVE OF ABSENCE INFORMATION
Preferred Version:	RTW FORM.pdf