Use this form for:

• full medical leave (complete pages 1, 2, 5 only)

• accessing accommodations, including partial medical leave (complete all pages)

• returning to work

Any health care professional can complete this form.

This is a convenient "one-pager" to aid in the planning process for returning to work.

When in doubt, contact Gabe, Staff Officer at Ottawa Catholic Teachers, at 613-723-0959.

**You must wait for Employee Wellness to approve your return to work, regardless of what your health care professional has said.