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Fill in a Valid Work Release Form

The Work Release form is a legal document that allows individuals, often those involved in the criminal justice system, to leave confinement for employment purposes. This form facilitates the transition back into society by enabling individuals to gain work experience while fulfilling their obligations. Understanding the intricacies of this form is essential for both individuals seeking employment opportunities and the authorities overseeing their rehabilitation.

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Common PDF Templates

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➤ PDF File

Example - Work Release Form

Return to Work Release and Work Ability

Employee Name: __________________________________________

Return to Work

Return to work with no limitations on ________/________/__________

Return to work with limitations on _________/_________/__________ (note limitations below)

Employee’s Capabilities

	Not	Occasio	Freque	Continuo
	at	nal	nt	us
Lift/Carry	all	0-33%	34-66%	67-100%
Lift/Carry				
0-9 lbs				
10-19 lbs				
20-29 lbs				
30-39 lbs				
40-49 lbs				
No lifting				
Push/Pull without resistance
0-19 lbs				
20-40 lbs				
> 40 lbs				

Bend				
Twist/turn				
Kneel/squat				
Sit				
Stand/walk				
Ladder/stair				
climb

Hand, wrist, and shoulder activities
Avoid prolonged, repetitive, or forceful:
Gripping/grasping				
Repetitive wrist				
motion
Reaching
Above				
shoulder				
At shoulder				
height
Below				
shoulder

This treatment has been discussed with the employee.

Restrictions (circle)
Keyboarding / hrs	0	1 - 2	3 – 4	5 – 6	7+
Writing / hrs	0	1 - 2	3 – 4	5 – 6	7+

Change positions every:

As needed

Half hour

One hour

Two hours

Worksite stretches

Exercises

Other

Comments:

_________________________________________________	__________________________
Physician Signature	Date

Documents used along the form

When dealing with the Work Release form, several other documents and forms often accompany it to ensure a smooth process. Each of these documents serves a specific purpose, making it essential to understand their roles. Here’s a brief overview of six commonly used forms related to work release.

Employment Verification Form: This document confirms an individual’s employment status, detailing job title, duration of employment, and salary. It is often required to validate the conditions under which a work release is granted.
Release of Liability Form: This form protects the employer from legal claims that may arise from the employee's participation in work-related activities. It outlines the risks involved and confirms that the employee accepts them.
Work Schedule Agreement: This document specifies the hours and days the employee is allowed to work while on release. It helps to establish clear expectations for both the employer and the employee.
Mobile Home Bill of Sale Form: When transferring ownership of a mobile home, use our detailed Mobile Home Bill of Sale guidelines to ensure all necessary information is documented appropriately.
Progress Report: Often required during the work release period, this report provides updates on the employee’s performance and compliance with the terms of the release. It is a valuable tool for monitoring progress.
Reintegration Plan: This plan outlines the steps for transitioning the employee back into full-time work after the release period. It may include training, support services, and timelines for reintegration.
Behavioral Agreement: This document sets forth the behavioral expectations for the employee during their work release. It often includes guidelines for conduct and consequences for violations.

Understanding these forms and documents can significantly enhance the work release process. Each plays a crucial role in ensuring that all parties are on the same page, fostering a successful transition back into the workforce.