_ 2026/Mar/24 2:02:13 PM Translink 555-1212 416
_ inv 315113 - attached

= pret ES EARNS.
— FAXED —
2026-03-26, 1:46:30 PM

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OCCUPATIONAL FITNESS ASSESSMENT (OFA)
CONFIDENTIAL INFORMATION (To be completed by attending physiclon)

Mark Holand £21987
Guideway Serviceperson

BASafety Critical © OSafety Sensitive
Please refer to Canadian Railway Medical Rules Handbaok for Positions Critical to Safe Rallway Operations,
iy allean.ca/publicatio dian-rallway-medical-rules-hondboo!

Date of injury/liiness: [1 SA Zozb ex6ccupational O Non-Occupational

General Nature of llness/injury (specific diagnosis not required); . ;
figichon, ASeMain, Paps appetite | Gnaithy pay ody e

Secondary Nature of Illness (if any):

Is there a recommended Treatment Plan: wi O No

Patlent|s compliant with Recommended Treatment: A O No
Date of most racent visit: i mAL 20° o

Next planned visit:_ 27-1 A 2027 lo
Is your patlent taking any medication that could impact their ability ta perform work safely and

productively?
mes QO No

laa lain limitations and restrict!
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(or Ki Fovsninnn) (on (a reen PrHal) Coe imu SANAD)

Is the patient medically cleared to return to full dutles without any limitatlon and restriction?

CiYesrskip to signature page (page 4)
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