The Return To Work Claim Form is a critical document in Singapore's workplace safety and health framework. This form is required when an employee seeks to resume work following a work-related injury or illness, as maNDAted by Singapore's Work Injury Compensation Act. The form must be completed to document the transition back to work, including medical clearance, work capacity assessment, and any necessary workplace accommodations. It serves multiple purposes: ensuring legal compliance, facilitating insurance claims, protecting both employer and employee interests, and promoting safe return-to-work practices.
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1. Employee Information: Personal details including name, NRIC/FIN, contact information, employment status, job title and department
2. Injury/Illness Details: Nature of injury/illness, date and time of occurrence, circumstances of incident, and location where incident occurred
3. Medical Information: Details of medical treatment received, attending physician information, hospital/clinic details, and medical certificates issued
4. Work Status Declaration: Current work capacity assessment, intended return date, and any work restrictions
5. Employee Declaration: Declaration of truth and accuracy of information provided, with employee signature and date
1. Light Duties Request: Section for requesting modified duties when employee has partial work capacity as certified by medical professional
2. Workplace Accommodation: Details of special arrangements or modifications needed in the workplace to facilitate return to work
3. Third Party Claims: Information regarding any third party liability or related insurance claims
1. Medical Certificates: Appendix containing copies of all relevant medical certificates and sick leave documentation
2. Treatment Records: Appendix containing supporting medical documentation, treatment records, and physician reports
3. Incident Reports: Appendix containing workplace accident reports and any related investigation findings
4. Return to Work Plan: Schedule outlining the detailed plan for gradual return to full duties, including timeline and milestones
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