Request for Temporary Light Duty Assignment Request
This file contains a formal request for temporary light duty assignments for employees with non-work related injuries or illnesses. It includes necessary medical documentation and specific sections for employees, supervisors, and medical professionals to complete. Use it to ensure compliance with work accommodation regulations.
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How do I fill this out?
To fill out this form, start by providing your personal and contact information in Part A. Next, have your immediate supervisor complete Part B to assess work availability in your unit. Finally, ensure that the Postmaster or Plant Manager reviews and signs Part C for approval.
How to fill out the Request for Temporary Light Duty Assignment Request?
1
Complete Part A with your details and attach medical documentation.
2
Submit Part A to your immediate supervisor for review.
3
Have your supervisor complete Part B regarding work availability.
4
Submit the form to the Postmaster or Plant Manager for approval.
5
Await notification of approval or denial, including any necessary reasoning.
Who needs the Request for Temporary Light Duty Assignment Request?
1
Employees needing light duty due to health conditions.
2
Supervisors who need to assess employee work capabilities.
3
Postmasters or Plant Managers for processing light duty requests.
4
Medical professionals providing documentation and evaluations.
5
HR personnel reviewing compliance with accommodation policies.
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1
Open the PDF in the PrintFriendly editor.
2
Select the text fields you wish to edit and make your changes.
3
Add any necessary comments or notes relevant to your request.
4
Review the edited document for any errors or omissions.
5
Save the final version of the PDF for submission.
What are the instructions for submitting this form?
To submit this form, make sure all sections are completed accurately and signed where required. You may submit the form via email to your HR department, or fax it to the designated number. For physical submission, provide the completed form to your immediate supervisor or HR office. Ensure you keep a copy for your records. Following these instructions will help streamline the processing of your request.
What are the important dates for this form in 2024 and 2025?
Key dates related to this form include submission deadlines specific to temporary light duty requests. Ensure you submit your request timely to allow for processing. Stay informed about any changes to medical accommodation policies in 2024 and 2025.
What is the purpose of this form?
The purpose of this form is to formally request temporary light duty assignments for employees who are recovering from non-work related injuries or health issues. By completing this form, employees communicate their need for accommodation to their supervisors and HR personnel. It serves as a structured method for ensuring compliance with workplace regulations and facilitating the return to work process.
Tell me about this form and its components and fields line-by-line.
- 1. Employee's Printed Name: The name of the employee requesting light duty.
- 2. Social Security Number: The employee's social security number for identification.
- 3. Office/Tour: The office or service area where the employee works.
- 4. Phone Number: The employee's contact number.
- 5. Physician's Name: Name of the physician preparing the medical documentation.
- 6. Physician's Address: The address of the employee's physician.
- 7. Signature/Date: The employee's signature and the date of the request.
What happens if I fail to submit this form?
Failure to submit this form can result in delays or denials of light duty accommodations. It is essential to complete all required sections to avoid complications in processing your request. Proper submission allows supervisors and HR to effectively support your work needs.
- Delay in Approval: Incomplete forms may lead to a slow approval process.
- Denial of Accommodation: Missing information can result in denial of the light duty request.
- Workplace Complications: Failure to submit may lead to misunderstandings regarding work assignments.
How do I know when to use this form?
- 1. Post-Injury Recovery: Employees recovering from injuries may need modified work.
- 2. Post-Surgery Compliance: Employees returning to work after surgery may require specific accommodations.
- 3. Chronic Health Conditions: Those with ongoing health issues may need temporary light duty work.
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