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THE UNIVERSITY OF RHODE ISLAND
PHYSICIAN’S CERTIFICATION – EMPLOYEE’S SICK
LEAVE
I certify _________________________ and
Employee’s Name
he/she is not able to carry out the duties of his/her position (as specified in his/her job description), or his/her condition presents a health and/or safety threat to other employees or students.
Beginning Date:_______________________
Expected Date of Return:________________
___________________________
Physician’s Signature
____________________________
Physician’s Name (Typed or printed)
_________________
Date
Please return this certificate to:
Laura Kenerson
Director, Personnel Services
The University of Rhode Island
80 Lower College Road
Kingston, RI 02881
