GBEE Modified Work Program Form
To be completed by attending medical practitioner.
The Fort McMurray Public School District has a Modified work program and will adhere to the restrictions you place on our employee. It is to every ones benefit to be able to maintain productive employment.
Performance Limits Agreement
I UNDERSTAND THAT THE FOLLOWING LIMITS HAVE BEEN SET FOR ME. I AGREE NOT TO EXCEED THESE LISTED LIMITS.
SHOULD ANY CHANGE BE REQUIRED FROM THESE ESTABLISHED LIMITS, A NEW FORM MUST BE COMPLETED.
CLINIC/HOSPITAL NAME: _________________________________________________________________
EMPLOYEE: _____________________________________________________ DATE: _______________