We will determine the possibility of a trial return to work based on "Certificate of Diagnosis Description"＆ "Request for Provision of Information", so we cannot proceed to the industrial physician interview unless the following documents,including "Certificate of Diagnosis Description", are complete.
<Documents to be submitted at the start of the trial return to work>
・[Form1-1] Certificate of Diagnosis Description＆ [Form2-1] Request for Provision of Information_20230101 (prepared by the primary physician)
・[Form 3] Application for Trial Attendance_201604.docx (prepared by the employee on leave)
・[Form 4(1)] Self-Checklist for the Recovery Condition_201604.docx (prepared by the employee on leave).
*If the content of "Certificate of Diagnosis Description" is fully covered, documents in the medical institution's format may also be accepted.
*While employees on a long absence from work for illnesses related to pregnancy, their
“maternity health care guidance item contact card” may be used as a substitute for a
"Certificate of Diagnosis Description", however, that the card includes information on the day the employee can return to work, and any work restrictions which may apply.