University of Rochester
EMERGENCY INFORMATIONCALENDARDIRECTORYA TO Z INDEXCONTACTGIVINGTEXT ONLY

    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) :