The Work Release form is a legal document that allows individuals to leave a correctional facility temporarily for employment purposes. This form is essential for those seeking to reintegrate into the workforce while still serving their sentence. It outlines the terms and conditions under which the individual may work outside the facility.
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%
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
This treatment has been discussed with the employee.
Restrictions (circle)
Keyboarding / hrs
0
1 - 2
3 – 4
5 – 6
7+
Writing / hrs
Change positions every:
As needed
Half hour
One hour
Two hours
Worksite stretches
Exercises
Other
Comments:
_________________________________________________
__________________________
Physician Signature
Date
Understanding the Work Release form is crucial for both employees and employers. However, several misconceptions can lead to confusion. Here’s a list of ten common misunderstandings about the Work Release form:
By addressing these misconceptions, employees and employers can navigate the Work Release process more effectively and ensure that everyone understands their rights and responsibilities.
Here are some key takeaways about filling out and using the Work Release form:
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