DKC – Policy Exhibit 2

Garfield County School District

Certificate of Fitness for Duty

_______________________ (employee’s name) is a patient of mine.  It is my understanding that _______________________’s (employee’s name) employment with the Garfield County School District requires him/her to be able to perform the following activities with accompanying weekly time requirements:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

            On ______________,(date) I personally evaluated ____________________ (employee’s name).  I certify that based upon my education and clinical expertise ______________________ (employee’s name) is fit to return to his/her employment with the ____________________ District. 

                                                                                                                                                                                             ____________________________________

Signature

____________________________________

Title