University of Rochester

Office of Human Resources

Comments?

Return from Disability /
Workers' Compensation Report

Employee Information

Name:  
Employee ID:  
Return to Work Date:      Nursing Practice Member  

Restrictions:

Limit to hours per day
Twisting
Bending
Limit lifting to pounds
Repetitive Motion
Other:
Date to End Restrictions:


Reporter's email address (required):  

We appreciate your comments and suggestions
magnifying glass