About this Form
Form number: 440-40M
Audience: Attending Physician, MCPS Staff
Last revised: April 2013
Form 440-40S - Return to Work Evaluation: SEIU Employees
PART I—Employee: The employee completes Part I of this form and accesses his/her job description via http://montgomeryschoolsmd.org/departments/personnel. If the job description is unavailable, the employee should contact his/her immediate supervisor.
PART II—Physician or Health Care Practitioner: The physician or health care provider should review the employee’s current job description, complete Part II and III of this form, and return the form to the employee.
See Related Form 440-40S for Return to Work Evaluation: SEIU Employees
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