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The Statement Of Fitness For Work Form is a standardized document used across Nigerian industries to manage employee health and workplace safety compliance. This form becomes necessary when an employee returns to work after illness or injury, requires workplace accommodations, or needs certification of their fitness for specific job duties. It serves as a critical communication tool between healthcare providers, employers, and employees, ensuring compliance with Nigerian labor laws, particularly the Labour Act and Factories Act. The document helps protect both employer and employee interests by providing clear medical guidance while maintaining patient confidentiality. It's especially relevant in industries with specific safety requirements or where regular fitness assessments are mandatory under Nigerian regulations.

1. Patient Information: Essential identifying details including full name, date of birth, address, and employment details

2. Healthcare Provider Details: Information about the medical professional issuing the certificate, including name, qualification, registration number, and practice details

3. Assessment Date: Date of medical examination and assessment

4. Medical Assessment: Primary section indicating whether the patient is 'Not fit for work' or 'May be fit for work subject to following advice'

5. Duration: Period for which the assessment applies, including start and end dates

6. Work Modifications: Specific recommendations for workplace adjustments if 'May be fit for work' is selected

7. Clinical Information: Brief description of the condition affecting work capability (within confidentiality limits)

8. Declaration: Healthcare provider's signature, stamp, and date of certification