western work form

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Return form to Human Resources Western Oregon University 345 N Monmouth Avenue Monmouth OR 97361 Ph 503-838-8490 FAX 503-838-8144 Name of worker RELEASE TO RETURN TO WORK ID Number Please complete the following information and return to us at the address indicated above. 1. Is the worker medically stationary Yes No Date Next scheduled appointment date 2. Worker is released to full duty without limitations modified duty from date Do not complete lines 3 through 11. Sign below. through date...
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