DKC-E2
| Policy Exhibit #2 | dKC |
___________________District
Certificate of
Fitness for Duty
_______________________ (employee’s name) is a patient of mine. It is my understanding that _______________________’s (employee’s name) employment with the __________ School District requires him/her to be able to perform the following activities with accompanying weekly time requirements:
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On ______________,(date) I personally evaluated ____________________ (employee’s name). I certify that based upon my education and clinical expertise ______________________ (employee’s name) is fit to return to his/her employment with the ____________________ District.
____________________________________
Signature
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Title
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