J. J. Keller & Associates, Inc.
Employee’s Request for Light Duty Work Form, 8.5 x 11, 75 Pack, J. J. Keller & Associates, Inc.
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R 772
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Description
- LIGHT DUTY: Request for light work form should be completed by a healthcare provider along with employee requesting light duty due to an injury. Request would be needed in the case of limitations keeping employee from completing regular duties.
- DESIGN: HR form is designed with plenty of space and appropriate fields for healthcare provider to provide necessary information explaining employee’s limitations. Once completed by employee and provider a supervisor can add notes along with approval.
- QUALITY: Form is printed on quality bond paper. English only. Made in the USA.
- SIZE: Measures 8 1/2” x 11”. Pack of 75 sheets.
Technical Specifications
Manufacturer
J. J. Keller & Associates, Inc.
Model
68170
Size
75-Pack
Height
0 cm
Length
27.9 cm
Width
21.6 cm
Shipping & Delivery
Your order is shipped from the USA and delivered to your door in South Africa in 10–20 working days. All items are fully tracked.
Returns & Exchanges
We offer a 30-day return window. If something isn't right, contact our support team and we'll make it right.