Excuse from Work or School
Name_____________________________ needs to be excused from work/school/physical education for the following dates:
___________________________________________________________.
He/she may return to work/school but must still avoid physical activity as of this date:__________________________________.
He/she may return to full physical activity as of this date: _______________________.
Additional comments/instructions:
Printed name: _________________________________
____________________________________________________________
Signature Title Date
This content is reviewed periodically and is subject to
change as new health information becomes available. The
information is intended to inform and educate and is not a
replacement for medical evaluation, advice, diagnosis or
treatment by a healthcare professional.
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