Common use of Other Retirement Gratuities Clause in Contracts

Other Retirement Gratuities. An employee is not eligible to receive any non-sick leave credit retirement gratuity (such as, but not limited to, service gratuities or RRSP contributions) after August 31, 2012. Employee Group: Requested By: WSIB Claim: Yes No WSIB Claim Number: Employee Name: (Please print) Employee Signature: 1. Health Care Professional: The following information should be completed by the Health Care Professional Please check one: Patient is capable of returning to work with no restrictions. Patient is capable of returning to work with restrictions. Complete section 2 (A & B) & 3 I have reviewed sections 2 (A & B) and have determined that the Patient is totally disabled and is unable to return to work at this time. Complete sections 3 and 4. Should the absence continue, updated medical information will next be requested after the date of the follow up appointment indicated in section 4. First Day of Absence: General Nature of Illness (please do not include diagnosis): Date of Assessment: dd mm yyyy