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This document provides information regarding the modified or accommodated duty for employees returning to work after injury or illness. It outlines details like return date, current position information,

How to fill out modified dutyaccommodated duty statement

How to fill out Modified Duty/Accommodated Duty Statement

1. Begin by accessing the Modified Duty/Accommodated Duty Statement form from your employer's human resources or safety department.
2. Fill in your personal information, including your name, employee ID, and department.
3. Describe the nature of your injury or health condition clearly and concisely.
4. Specify the type of modified or accommodated duties you are able to perform.
5. If applicable, include any recommendations from your healthcare provider regarding your capabilities.
6. Obtain necessary signatures from your supervisor or manager and your healthcare provider, if required.
7. Submit the completed form to the appropriate department for review.

Who needs Modified Duty/Accommodated Duty Statement?

1. Employees who have sustained an injury or have a medical condition that affects their ability to perform regular job duties need a Modified Duty/Accommodated Duty Statement.

People Also Ask about

What are job modifications?

A job modification is an adjustment or alteration to the way a job is performed. The modification may be temporary during recovery or permanent.

What is a modified job description?

Modified Duty is a program that allows you to return to work while you are recovering from your illness or injury. You will perform a set of tasks or assignments that may or may not be the same type of work you do in your regular job. These tasks can change as your condition improves.

What does "modified" mean on a work schedule?

A modified schedule may involve adjusting arrival or departure times, providing periodic breaks, altering when certain functions are performed, allowing an employee to use accrued paid leave, or providing additional unpaid leave.

What is the any other duties clause?

The "Other Related Duties" clause defines the requirement for an employee to perform tasks beyond those specifically listed in their job description, as long as these tasks are reasonably related to their primary responsibilities.

What is the meaning of modified work?

Modified work means that your employer makes changes to your duties or your workplace because your injury prevents you from doing some parts of your regular job. This includes: working in a different job or different area of your workplace. doing parts of your job and having someone help with the parts you can't do.

What is modified duty injury?

When an injury occurs, the goal for both the workplace and the worker is to get things back to the way they were before the injury. This is where modified duties come in: Modified duties are any temporary changes to the worker's job tasks, functions or workload.

What are modified duties examples?

Modified duties could include modified hours of work, ability to work remotely, a change in the frequency or duration of breaks, or reduction of certain duties. Modified duties are often temporary, such as to facilitate a return to work after an injury or leave.

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What is Modified Duty/Accommodated Duty Statement?

The Modified Duty/Accommodated Duty Statement is a formal document used to outline the specific duties and accommodations available for employees who are returning to work after an injury or illness.

Who is required to file Modified Duty/Accommodated Duty Statement?

Employers are generally required to file the Modified Duty/Accommodated Duty Statement when an employee is returning to work with restrictions or modified duties due to a medical condition.

How to fill out Modified Duty/Accommodated Duty Statement?

To fill out the Modified Duty/Accommodated Duty Statement, employers should provide employee information, detail the modified work duties, outline specific accommodations, and include any relevant medical recommendations.

What is the purpose of Modified Duty/Accommodated Duty Statement?

The purpose of the Modified Duty/Accommodated Duty Statement is to ensure a safe and supportive return to work for employees with restrictions, while also maintaining workplace productivity and compliance with injury management policies.

What information must be reported on Modified Duty/Accommodated Duty Statement?

The information that must be reported includes the employee's name, job title, date of injury, medical restrictions, proposed modified duties, and any accommodations that will be provided to facilitate their return to work.