Documentation Information and Forms

What documentation do I need to submit for a medical absence / sick leave? 

For medical absences 5 business days (or more), the Sick Leave Return to Work Form (PDF) must be completed by your healthcare practitioner.  

Completed forms / documentation can be submitted to OccupationalHealth@uwaterloo.ca and will be stored in alignment with confidentiality and privacy requirements. 

Note: If you believe that your injury or illness arose out of, and in the course of your employment, please complete an Incident and Investigation Report Form with your supervisor. Medical aid and lost time injuries are managed by the Safety Office. Incident reports and Workplace Safety & Insurance Board (WSIB) forms are to be sent to the  Safety Office.

What documentation do I need to apply for a workplace accommodation request?  

There are several forms that you could use to apply with our office that will assist us in the design of your individualized workplace accommodation plan.  Each form provides guidance on who may complete it.  Please select the form that you feel is most relevant to you and your needs.  

I am working with a regulated healthcare practitioner who is legally able to diagnose my disability/disabling condition who can complete documentation for me: 

EHA – Medical Disability Verification Form (PDF)

I am working with a practitioner to assess and treat my functional limitations (e.g. Social Worker, Physiotherapist, First Nations, Inuit, Metis Traditional Healer or Elder) who can complete documentation for me:  

EHA – Functional Limitation Verification Form (PDF) - this form is best used when a disability diagnosis is not appropriate, available or relevant (e.g. trauma, grief). This form may also be used in situations where you are not working with a physician on your assessment and treatment plan. 

I don’t have documentation and I am not currently working with a health care provider: 

No documentation? No worries. Start the application process by completing the Workplace Accommodation Request Form, and we will guide you through the rest of the process.

I am requesting an accommodation that requires specialized documentation: 

Medical Cannabis Request Verification Form (PDF)

Service Animal Verification Form (PDF)   

Verification of Animal's Health Form (PDF) 

Please note that it may take your practitioner a number of visits with you before they are able to adequately assess your functional limitations and complete documentation.  We encourage you to plan accordingly and begin working with your practitioner right away.

Obtaining documentation is your responsibility, including any fee associated with having documentation completed. If cost is a barrier, please contact us to schedule an appointment with a staff member to discuss the options available to you.  

  • 519-888-4567, ext. 40538 (Karen Parkinson, Manager Occupational Health) 

  • 519-888-4567, ext. 40551 (Cassie Hunter, Occupational Health Nurse) 

If you have questions about registering with our office and/or if you have encountered any unexpected barriers that are preventing you from engaging and participating in the application process, please contact us by phone:  

  • 519-888-4567, ext. 40538 (Karen Parkinson, Manager Occupational Health)