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Policy 115-Page 1 of 3 EARLY RETURN TO WORK / MODIFIED DUTY PROGRAM I. PURPOSE To establish a policy statement and procedures for uniform response and handling of an authorized modified duty/return

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How to fill out early return to work

How to fill out early return to work:

01

Obtain the necessary forms from your employer or human resources department. These forms may include a medical certification and a return to work plan.

02

Schedule an appointment with your healthcare provider to assess your condition and determine if you are ready to return to work. They will complete the medical certification form, documenting any restrictions or accommodations needed.

03

Fill out the employee section of the early return to work form, providing your personal information, contact details, and the date you wish to return to work.

04

Review the return to work plan and make any necessary adjustments based on your healthcare provider's recommendations. This may include modifying your tasks or work schedule to accommodate any restrictions.

05

Attach the completed medical certification form to the early return to work form. Ensure that all information is accurate and legible.

06

Submit the completed forms to your employer or human resources department. Follow any specific instructions they provide, such as submitting via email, fax, or in-person.

07

Keep a copy of the forms for your records and keep track of the date you submitted them.

08

Follow up with your employer to confirm receipt of the forms and to discuss any further steps or modifications required before your return to work.

Who needs early return to work:

01

Employees who have been on a medical leave or disability due to a health condition or injury and wish to return to work before their anticipated return date.

02

Individuals who have received medical clearance from their healthcare provider and are physically and mentally capable of resuming their job duties.

03

Those who have completed any necessary treatment or therapy and have met the requirements outlined in their return to work plan.

04

Employees who may require work modifications or accommodations to ensure a successful and safe transition back into the workforce.

05

Individuals who have followed their employer's policies and procedures regarding medical leaves and return to work requirements.

Note: It is important to consult with your employer and healthcare provider for specific instructions and guidelines regarding early return to work, as the process may vary depending on company policies and individual circumstances.

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What is early return to work?

Early return to work is a program that allows an employee to return to work on modified or light duty while they continue to recover from a work-related injury.

Who is required to file early return to work?

Employers are required to file early return to work for their employees who are participating in the program.

How to fill out early return to work?

Employers can fill out early return to work forms provided by their workers' compensation insurance carrier or state agency.

What is the purpose of early return to work?

The purpose of early return to work is to help injured employees return to work sooner, reduce workers' compensation costs, and maintain productivity.

What information must be reported on early return to work?

Employers must report the employee's job restrictions, accommodations made for the employee, and the expected duration of the modified duty.

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