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. APPENDIX B – ABILITIES FORM Employee Group: Requested By: WSIB Claim: Yes No WSIB Claim Number: To the Employee: The purpose for this form is to provide the Board with information to assess whether you are able to perform the essential duties of your position, and understand your restrictions and/or limitations to assess workplace accommodation if necessary. Employee’s Consent: I authorize the Health Professional involved with my treatment to provide to my employer this form when complete. This form contains information about any medical limitations/restrictions affecting my ability to return to work or perform my assigned duties. Employee Name: (Please print) Employee Signature: Employee ID: Telephone No: Employee Address: Work Location:

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. APPENDIX B – ABILITIES FORM FORM‌ Employee Group: Requested By: WSIB Claim: Yes No WSIB Claim Number: To the Employee: The purpose for this form is to provide the Board with information to assess whether you are able to perform the essential duties of your position, and understand your restrictions and/or limitations to assess workplace accommodation if necessary. Employee’s Consent: I authorize the Health Professional involved with my treatment to provide to my employer this form when complete. This form contains information about any medical limitations/restrictions affecting my ability to return to work or perform my assigned duties. Employee Name: (Please print) Employee Signature: Employee ID: Telephone No: Employee Address: Work Location:

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. APPENDIX B – ABILITIES FORM FORM‌ Employee Group: Requested By: WSIB Claim: Yes No WSIB Claim Number: To the Employee: The purpose for this form is to provide the Board with information to assess whether you are able to perform the essential duties of your position, and understand your restrictions and/or limitations to assess workplace accommodation if necessary. Employee’s Consent: I authorize the Health Professional involved with my treatment to provide to my employer this form when complete. This form contains information about any medical limitations/restrictions affecting my ability to return to work or perform my assigned duties. Employee Name: (Please print) Employee Signature: Employee ID: Telephone No: Employee Address: Work Location:

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. APPENDIX B – ABILITIES FORM Employee Group: Requested By: WSIB Claim: Yes No WSIB Claim Number: To the Employee: The purpose for this form is to provide the Board with information to assess whether you are able to perform the essential duties of your position, and understand your restrictions and/or limitations to assess workplace accommodation if necessary. Employee’s Consent: I authorize the Health Professional involved with my treatment to provide to my employer this form when complete. This form contains information about any medical limitations/restrictions affecting my ability to return to work or perform my assigned duties. Employee Name: (Please print) Employee Signature: Employee ID: Telephone No: Employee Address: Work Location:

Other Retirement Gratuities. An employee A Teacher is not eligible to receive any non-sick leave credit retirement gratuity (such as, but not butnot limited to, service gratuities or RRSP contributions) after August 31, 201231,2012. APPENDIX B – ABILITIES FORM Employee Group: Requested By: WSIB Claim: Yes No WSIB Claim Number: To the Employee: The purpose for this form is to provide the Board with information to assess whether you are able to perform the essential duties of your position, and understand your restrictions and/or limitations to assess workplace accommodation if necessary. Employee’s Consent: I authorize the Health Professional involved with my treatment to provide to my employer this form when complete. This form contains information about any medical limitations/restrictions affecting my ability to return to work or perform my assigned duties. Employee Name: (Please print) Employee Signature: Employee ID: Telephone No: Employee Address: Work Location:

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. Return to TOC Return to Key Terms APPENDIX B – ABILITIES FORM Employee Group: Requested By: WSIB Claim: Yes No WSIB Claim Number: To the Employee: The purpose for this form is to provide the Board with information to assess whether you are able to perform the essential duties of your position, and understand your restrictions and/or limitations to assess workplace accommodation if necessary. Employee’s Consent: I authorize the Health Professional involved with my treatment to provide to my employer this form when complete. This form contains information about any medical limitations/restrictions affecting my ability to return to work or perform my assigned duties. Employee Name: (Please print) Employee Signature: Employee ID: Telephone No: Employee Address: Work Location:

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. APPENDIX B – ABILITIES FORM FORM‌‌ Employee Group: Requested By: WSIB Claim: Yes No WSIB Claim Number: To the Employee: The purpose for this form is to provide the Board with information to assess whether you are able to perform the essential duties of your position, and understand your restrictions and/or limitations to assess workplace accommodation if necessary. Employee’s Consent: I authorize the Health Professional involved with my treatment to provide to my employer this form when complete. This form contains information about any medical limitations/restrictions affecting my ability to return to work or perform my assigned duties. Employee Name: (Please print) Employee Signature: Employee ID: Telephone No: Employee Address: Work Location:

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. APPENDIX B – ABILITIES FORM Employee Group: Requested By: WSIB Claim: Yes No WSIB Claim Number: To the Employee: The purpose for this form is to provide the Board with information to assess whether you are able to perform the essential duties essentiadl uties of your position, and understand your restrictions and/or limitations to assess workplace accommodation if necessary. Employee’s Consent: Emp I authorize the Health Professional involved with my treatment to provide to my employer this form when complete. This form fomr contains information about any medical limitations/restrictions affecting my ability to return to work or perform my performmy assigned duties. Employee Name: (Please print) Employee Signature: Employee ID: Telephone No: Employee Address: Work Location:

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. APPENDIX B – FUNCTIONAL ABILITIES FORM FORM‌ Employee Group: Requested By: WSIB Claim: Yes No WSIB Claim Number: To the Employee: The purpose for this form is to provide the Board with information to assess whether you are able to perform the essential duties of your position, and understand your restrictions and/or limitations to assess workplace accommodation if necessary. Employee’s Consent: I authorize the Health Professional involved with my treatment to provide to my employer this form when complete. This form contains information about any medical limitations/restrictions affecting my ability to return to work or perform my assigned duties. Employee Name: (Please print) Employee Signature: Employee ID: Telephone No: Employee Address: Work Location:

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. APPENDIX B – ABILITIES FORM Employee Group: Requested By: WSIB Claim: Yes No WSIB Claim Number: To the Employee: The purpose for this form is to provide the Board with information to assess whether you are able to perform the essential duties of your position, and understand your restrictions and/or limitations to assess workplace accommodation if necessary. necessar y. Employee’s Consent: I authorize the Health Professional involved with my treatment to provide to my employer this form when complete. This form contains information about any medical limitations/restrictions affecting my ability to return to work or perform my assigned duties. Employee Name: (Please print) Employee Signature: Employee ID: Telephone No: Employee AddressEmploye e Address : Work Location:

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, 201231,2012. APPENDIX B – - ABILITIES FORM Employee Group: Requested By: WSIB ClaimWSIBCiaim: Yes No DYes 0No WSIB Claim Number: To the Employee: The purpose for this form is to provide the Board with information to assess whether you are able to perform the essential duties of your position, and understand your restrictions and/or limitations to assess workplace accommodation if necessary. Employee’s 's Consent: I authorize Iauthorize the Health Professional involved with my treatment to provide to my employer this form when complete. This form contains information about any medical limitations/restrictions affecting my ability to return to work or perform my assigned duties. Employee Name: Employee Signature: (Please print) Employee Signature: Employee ID: Telephone No: Employee Address: Work Location: