Healthcare Worker Fitness for Duty Verification

Inspection template for verifying a healthcare worker's fitness for duty after an incident, leave, or other return-to-work event.

Inspection Details

• Worker name recorded
• Job title and department recorded
• Return-to-work trigger documented
• Return-to-work date documented

Medical and Occupational Health Clearance

• Occupational health or treating provider clearance received
• Clearance specifies ability to perform essential job functions
• Any current restrictions are documented
• Restriction end date or review date recorded
• Accommodation plan communicated to supervisor

Essential Job Function Readiness

• Able to safely lift, transfer, or assist patients as required by role
• Able to stand, walk, or remain on feet for required shift duration
• Able to perform required clinical tasks without unsafe limitation
• Able to use required PPE and follow infection-control procedures
• Any task-specific limitations identified

Safety, Behavior, and Readiness Review

• No current signs of impairment affecting safe work performance
• Worker understands reporting expectations for symptom recurrence or restriction changes
• Supervisor confirms readiness for assigned duties
• Any safety concerns or non-conformances identified

Final Authorization and Follow-Up

• Return-to-work status selected
• Next review date scheduled if restrictions remain
• Corrective actions or accommodations assigned
• Inspector signature completed