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THE UNIVERSITY OF RHODE ISLAND

PHYSICIAN'S CERTIFICATION - EMPLOYEE'S SICK LEAVE

I certify that  I am treating ___________________________________ and he/she is not able to carry  out the
                                        Employee's Name

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