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Return to Work Evaluation: SEIU Employees

About this Form

Form number: 440-40S

Audience:  Attending Physician, MCPS Staff

Last revised: April 2013

Related Forms

Form 440-40M - Return to Work Evaluation: MCEA 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 440-40M for Return to Work Evaluation: MCEA Employees

Adobe PDF Return to Work Evaluation: SEIU Employees170 KEnglish

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