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Employee Functional Assessment Form

Eastern Health is committed to supporting our employees’ health and well-being.
We believe that every member of the Eastern Health team plays an important role in providing the best care possible to our clients, residents, patients and their families. Our employees are our most valuable resource in providing quality care and service.
Eastern Health offers ease-back and modified work programs for employees who are unable to fully return to work as a result of illness or injury. As a result, the office of Occupational Health and Rehabilitation will work with you, and your health care provider, to ensure an early and safe return to work.
If you have been absent for five days or more, employees are required to complete the form below: 
Please follow the instructions on the form to ensure the FAF is submitted within the time frame required. This form is not required for a workplace injury.
Note: Any medical information provided is held confidential, and it also helps to support and or inform the organization’s rehabilitation initiatives and health promotion activities. 
For more information, please contact the office of HR - Occupational Health and Rehabilitation at:
  • St. John’s Region: 709-777-2526 or
  • Toll-free: 1- 877-704-5422

A full listing of service sites is available on the Functional Assessment Form (PDF).



Updated Mar 12, 2020