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work confirmation form

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End of RTWWBAs completed:ALMAT:Comments:Confirmation by returning AnaesthetistI feel confident in all respects to recommence full duties on:____________________________________Signed: _________________ Printed:__________________ Date:____________________Confirmation by Lead (e.g. educational supervisor, clinical lead)I concur that (applicant’s name) ______________________________ has confirmed their confidence andhas been observed to be competent to return to full duties.Signed: _________________ Printed:__________________ Date:____________________

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