Work Release Form
Document medical clearance for work — restrictions, duties and dates, signed by the right people.
A ready-to-use human resources form for HR, people ops and hiring managers: 11 questions, 1 page, 3 conditional rules.
- Questions
- 11
- Pages
- 1
- Layouts
- classic · card
- Conditional rules
- 3
Searches this template answers
Live preview and test console
This is the real form. Answer it to test the 1 conditional rule — nothing is sent or stored.
1 question is hidden by conditional logic right now — change an answer above to reveal it.
Compliance checklist
- Payment items priced — passingEvery payment question charges a real amount, so a submission always records a payment.
- Conditional logic resolves — passingEvery rule points at a question or page that exists in this template.
- Medical disclaimer present — passingThis form does not provide medical advice, diagnosis or treatment. Information you share here is not a substitute for care from a qualified clinician. In an emergency, contact your local emergency service immediately.
- Question labels unique — passingLogic and exports address questions by label, so duplicates are ambiguous.
What happens after submit: nothing is stored in this preview. On your own copy, every response triggers an instant email notification and lands in your response dashboard, ready to export or forward.
Happy with it? Take a copy into your workspace — every question, rule and setting comes with it.
Who this template is for
Work Release Form is built for HR, people ops and hiring managers who need to run hiring and internal people processes on one auditable record.
- HR, people ops and hiring managers working in human resources.
- Teams who need to run hiring and internal people processes on one auditable record without writing code or paying for a custom build.
- Anyone replacing CVs, requests and approvals scattered across inboxes with one structured record per enquiry.
- Respondents are candidates and employees — the form asks them 11 questions across 1 screen.
- Mobile-heavy audiences, thanks to the one-question-per-screen card layout.
Why this form is useful
It removes the cost of CVs, requests and approvals scattered across inboxes and turns each submission into a record your team can act on immediately.
- 6 questions are required, so submissions arrive complete instead of needing a follow-up email.
- It accepts a document or photo upload as evidence.
- It records a signature you can keep as proof of agreement.
- It pins the request to a specific date.
- Conditional logic hides 3 questions until they are relevant — shorter forms convert better than long ones.
- Every response is stored, searchable and exportable, so nothing depends on one person's inbox.
How to use this template
From copy to live form is a few minutes of work, and every step is reversible.
- 1Press “Use this template” — a fresh copy of Work Release Form lands in your workspace, ready to edit.
- 2Rename or delete any question, and change what is required. Nothing here is fixed.
- 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
- 4Check the upload limits on the file question so respondents can attach what you actually need.
- 5Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
- 6Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.
Logic and conditions blueprint
Exactly how this form behaves as it is answered — 3 conditional rules ship with it.
- Features conditional validation: if “Cleared to return?” is Restricted duties, “Restrictions detail” becomes mandatory before the form can be sent.
- Features advanced show logic: if “Cleared to return?” is Not cleared, the form dynamically exposes “Next review date”. Otherwise that question never appears.
- Features conditional validation: if “Cleared to return?” is Not cleared, “Next review date” becomes mandatory before the form can be sent.
- All 3 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.
About this template
A work release form is the record that says a clinician has cleared someone to work, and on what terms. It captures the employee, their job title, the department, the absence dates, and then the decision itself: cleared for full duties, cleared for restricted duties, or not cleared. Where duties are restricted, the specifics matter more than anything else on the page — no lifting above ten kilograms, no driving, no night shifts — which is why that description becomes required, along with a date the restriction is reviewed. The physician or clinic is named, the clearance document is attached, and the employee signs. It pairs with the Return to Work Form rather than duplicating it: that form is the HR conversation on the first day back, covering phased hours, adjustments and welfare. This one is the medical evidence underpinning it. Keeping them separate also keeps clinical detail out of the manager's copy. Two rules enforce the important parts: restricted duties require a written restriction, and 'not cleared' reveals a required next review date so nobody is left in limbo.
What this form asks
Every question is editable — rename it, make it optional, or delete it entirely.
Clearance record
- Employee namerequired
- Job titlerequired
- Employer or department
- Absence datesrequired
- Cleared to return?required
- Restrictions detail
- Restriction end date
- Next review date
- Physician or clinic namerequired
- Clearance document
- Employee signaturerequired
11 questions in total.
How the form changes as it's filled in
This template ships with 3 conditional rules, grouped into 3 behaviours driven by 1 question. Everything below is already set up — edit or delete any rule once the template is in your workspace.
Driven by “Cleared to return?”
- Makes answers required
If “Cleared to return?” is Restricted duties, “Restrictions detail” becomes required before the form can be submitted.
- Reveals questions
If “Cleared to return?” is Not cleared, the form reveals “Next review date”.
- Makes answers required
If “Cleared to return?” is Not cleared, “Next review date” becomes required before the form can be submitted.
Set it up step by step
- 1
Send it to the clinician, not the employee
Share the link with the treating clinic so the clearance is completed at source, with the employee signing at the end.
- 2
Keep the restrictions plain
Ask for practical limits — weights, hours, equipment — rather than diagnoses, which the employer does not need.
- 3
Diarise every review date
Set an automatic reminder from the review-date answer so restrictions get revisited instead of expiring silently.
- 4
Restrict who can see submissions
Health information belongs with HR or occupational health only; limit inbox access before you share the link.
Mistakes to avoid
- Recording 'restricted duties' with no description, which leaves a line manager guessing what the person is allowed to lift, drive or operate.
- Filing a restriction with no end or review date, so temporary light duties quietly become permanent.
- Collecting diagnosis details that the employer has no need to hold — clearance status and restrictions are enough.
What it pairs with
Most teams don't run this form on its own. These are the forms and systems it sits next to.
What to do with the responses
Give the line manager the restrictions and dates only, diarise the review date, and store the clearance document with the employee's occupational health record rather than in the team drive.
Works in both layouts
Forms that overlap this one
These pages cover the same subject ground as the work release form, matched on the words people actually search for.
Return to Work Form
employeeemploymentfithealthhiring
Time Off Request Form
dateemployeeemploymenthiringhr
Background Check Authorization Form
employeeemploymenthiringhrhuman
Remote Work Request
employeeemploymenthiringhrhuman
Contractor Agreement Intake
employeeemploymenthiringhrhuman
Employee Reference Request Form
employeeemployeremploymenthiringhr
Privacy & compliance
This form collects health information. Keep access limited to the people who need it, turn on encrypted answers for the clinical questions, and set a retention window so records don't sit in the dashboard forever.
Frequently asked questions
How is this different from the Return to Work Form?
This records the clinician's clearance and any medical restrictions. The Return to Work Form is the HR interview on day one — phased hours, adjustments, support and follow-up.
Can the employee complete it themselves?
They complete their own details and signature, but the clearance decision and clinician name should come from the treating clinic.
Do we need the clearance document uploaded?
Where your policy or insurer requires written evidence, yes. Otherwise the named clinician and signature are usually sufficient.
What if the restrictions cannot be accommodated?
Record that in the restrictions field and escalate to occupational health — the form documents the position, it does not decide it.
Is the Work Release Form template free to use?
Yes. You can preview and test Work Release Form on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.
What does the Work Release Form template ask for?
It asks 11 questions across 1 page, 6 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.
Can I edit the Work Release Form form after copying it?
Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.
How does the conditional logic in this human resources form work?
3 conditional rules ship with the template: Features conditional validation: if “Cleared to return?” is Restricted duties, “Restrictions detail” becomes mandatory before the form can be sent. Features advanced show logic: if “Cleared to return?” is Not cleared, the form dynamically exposes “Next review date”. Otherwise that question never appears. Features conditional validation: if “Cleared to return?” is Not cleared, “Next review date” becomes mandatory before the form can be sent. All rules are editable in the Logic tab.
Where do responses to the Work Release Form form go?
Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.
Can I embed the Work Release Form form on my own website?
Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.
Can respondents upload files?
Yes. This template includes a file upload question, so respondents can attach documents or photos with their answers. You can adjust the accepted file types and size limits on that question.
Is the signature on this form legally usable?
The template captures a drawn signature and stores it with the submission, along with the timestamp, so you keep evidence of who agreed and when. Whether that is sufficient depends on your jurisdiction and the agreement itself.
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