Medical Fitness Letter Template for HR Use

Subject: Medical Fitness Letter

Dear [Employee Name],

The purpose of this Medical Fitness Letter is to confirm the medical clearance requirements and fitness status for [Employee Name] in relation to employment with [Company Name]. This letter outlines the conditions, effective dates, and any actions required to satisfy the company medical fitness policy.

Employment Terms
Position: [Position]
Employee ID: [Employee ID]
Reporting Manager: [Manager Name]

Effective Dates
Medical evaluation date: [Medical Examination Date]
Required clearance by: [Medical Clearance Date]
Proposed start or return to work date: [Start Date]

Conditions or Actions Required
- The employee is required to complete the medical examination with the authorised medical practitioner named below and provide formal clearance documentation to HR by [Medical Clearance Date].
- Any recommended restrictions, accommodations, or follow up assessments must be submitted to Human Resources and the reporting manager promptly.
- Failure to provide the requested documentation by the specified date may affect the employee's start date or continued employment status.

Responsibilities and Acknowledgements
- The employee agrees to attend the medical assessment and to provide accurate health information to the examining practitioner.
- The medical practitioner will provide a written statement of fitness to work and any recommended limitations to [Company Name] Human Resources.
- [Company Name] will treat all medical information confidentially and will use it solely to assess fitness for role and necessary workplace adjustments.

Please submit the completed medical clearance and relevant documents to [HR Contact Email] or deliver to the HR office by [Medical Clearance Date]. If adjustments are required, your manager and HR will discuss reasonable steps and timing.

We appreciate your cooperation in completing the medical fitness process promptly. If you have questions about the process, contact [HR Name] at [HR Contact Email] or [HR Phone].

Warm regards,

[HR Name]
[HR Title]
[Company Name]

Acknowledgement
By signing below, I acknowledge receipt of this Medical Fitness Letter and agree to comply with the requirements stated above.
Employee signature: ____________________ Date: [Acknowledgement Date]