10+ Work Release Form Examples & Templates [Download Now]


A work release form is a form that is provided by the health centre authority to the concerned organization to describe the present health condition of its employee or worker, when he/ she will be able to join his or her duties, what restrictions the person should follow and when the person will be able to start his normal duties. It is necessary to describe all the restrictions in minute details especially for the employees who are employed in factory facilities for specialised jobs only.

The form should contain the name, address and employee designation in details. At the end as a footnote the health centre authority can also add some special instruction to the employee regarding special consequences that may happen as a result of the present health condition of the employee. Below we are providing 10+ Work Release Form Examples & Templates for your benefit in this regard.

Work Release Form Examples & Templates

1. Return to Work Release Form

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  • PDF

Size: 242 KB

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This is a form that is usually filled when an employee is absent for more than three working days due to non-work related injury or illness, upon return for work. It contains areas for the employee to fill out personal details and details of the nature of the illness or injury and any restrictions imposed if any. It is a very simple and basic document and is editable, printable and downloadable.

2. Work Release Capacities Form

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  • PDF

Size: 34 KB

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This is a form that outlines the work release capacities of the patient/ employee. The details are filled out by a physician and the document is very simple and is written in basic language. The document contains details employee name, activities that the employee is permitted to take part in, and the respective restrictions if any. The document is easily editable, downloadable and printable.

3. Physician’s Release to Return Work Release Form

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  • PDF

Size: 67 KB

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This is a very simple and basic form that is to be filled in by the physician. It contains many boxes to enter various details like the employee name, the treatment physician name, other details and also contains a tabulated structure that recommends the list of activities that a patient/ employee is allowed to take part in, on the basis of hours. The document is freely downloadable and printable.

4. Work Release Inmate Employment Schedule Form

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  • PDF

Size: 11 KB

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This is a form that is needed to be submitted to the prison or jail where a convict is imprisoned for a particular period of time. It contains the details of the convict, address and other contact details and all the details of the company where the convict has been sent for working by the Government as part of his punishment of ‘Rigorous Imprisonment’, its location and contact details. The form is a very simple and basic document and is editable, downloadable and printable.

5. Intent to Return Work Release Form

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  • PDF

Size: 94 KB

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This is a simple and basic work release form. Here the supervisor name and employee name are written down, and there is a medical release letter attached that allows the employee to return to work after being declared fit. It is editable, downloadable and printable as well.

6. Work Release Application Form

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  • PDF

Size: 150 KB

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This is an application form that must be filled and submitted to the relevant jail authority. It contains the defendant’s signature and employer details. This is again part of the ‘Rigorous Imprisonment’ punishment process, also called the ‘Work Release’ process. It is editable, downloadable and printable. The form is written in very basic language and is easy to fill.

7. Student Work Release Form

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  • PDF

Size: 23 KB

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This is a release form that is to be submitted by the student wherein the work done by them during research is also shared by them with the university for general publication for a limited period of time. It is a very basic and simple document and is easy to fill. The details of the student like name, address and photographs are also needed to be submitted. It is editable, downloadable and printable for free.

8. Medical Return to Work Release Form

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  • PDF

Size: 1 MB

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It is a simple and basic document that is to be filled up by the employee when the employee re-joins the organisation after an injury/ illness that was not related to the employee’s work. It contains various tables with boxes to provide details of the healthcare provider, work restrictions if any, follow-up care needed if any, and other details.

9. Creative Work Release Form

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  • PDF

Size: 61 KB

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This is the form that is filled up by an entity (company/ individual) to allow another company/ individual to use the entity’s creative works. The terms and conditions of the agreement are agreed upon beforehand.

10. Physician’s Notice to Work Release Form

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  • PDF

Size: 7 KB

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This is a notice filled up by the physician treating a patient, and this notice contains all the employee details and the conditions that must be met for the employee to return to work. The document is very simple and basic and is undersigned by the physician concerned.

11. Work Release Form Example

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  • PDF

Size: 145 KB

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The above sample template is a simple example of a generic work release form. It is easily editable, downloadable and printable and the example is self-explanatory. Anyone can make use of the same as it is an excellent example of its kind.

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