Free Medical Appointment Work Note Log PDF (Track Restrictions for Work)
Log appointments, restrictions, and whether work notes were delivered so HR and disability claims stay organized.
Published November 27, 2025
If you need proof of restrictions for HR, disability, or workers' comp, keeping a consistent log helps. This free tool records appointment dates, providers, work notes, and delivery to employers.
When to use this
- You received work restrictions and need to show HR what was provided.
- You are tracking appointments for disability, workers' comp, or accommodations.
- You want a single PDF showing which notes were delivered and any follow-up dates.
How to do it (fast)
- Open the Medical Appointment Work Note Log tool below.
- Enter your name, employer, date range, and each appointment with provider and reason.
- Mark whether a work note was issued, summarize restrictions, and note if it was delivered to your employer.
- Download the PDF instantly to email, print, or attach to a claim.
Why this helps
- Keeps sensitive medical work notes in one consistent PDF you control.
- Shows HR or attorneys which notes were delivered and what restrictions apply.
- Provides a defensible log for accommodation, disability, or retaliation disputes.
Related tools
- Medical leave request letter PDF
- Disability accommodation request log PDF
- Workers' comp medical evidence log PDF
Not legal advice. Courts set their own rules. Keep your original records.