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25 New Charon St Boston, MA 021144721 Phone: (617× 4886500 Fax: (617× 4886502 TRANSITIONAL MODIFIED DUTY AGREEMENT (company) is pleased to offer you a transitional modified duty assignment on a
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How to fill out transitional modified duty agreement
How to fill out transitional modified duty agreement:
01
Begin by carefully reading the agreement form to understand its terms and conditions.
02
Fill in the required personal information, such as your name, employee identification number, and contact details.
03
Provide details about your current position or job title, as well as the date when the agreement is being filled out.
04
If applicable, mention the date and circumstances of your injury or medical condition that require modified duty.
05
Indicate the type of transitional modified duty you will be performing, including any restrictions or accommodations that have been agreed upon.
06
If there are any temporary changes to your regular work schedule, be sure to note them in the agreement.
07
Sign and date the agreement, and ensure that a supervisor or authorized representative from your employer also signs the document.
08
Keep a copy of the completed agreement for your records.
Who needs a transitional modified duty agreement:
01
Employees who have suffered an injury or medical condition that requires them to temporarily perform modified duty tasks.
02
Employers who are providing accommodations for injured or disabled employees.
03
Human resources departments and managers who oversee workplace health and safety policies and procedures.
04
Insurance or workers' compensation providers who may require documentation of transitional modified duty arrangements.
Please note that it is important to consult with your employer's human resources department or legal counsel for specific guidance on filling out and implementing a transitional modified duty agreement, as the requirements may vary depending on your jurisdiction and company policies.
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What is transitional modified duty agreement?
Transitional modified duty agreement is an agreement between an employer and an injured employee to provide temporary work assignments with reduced physical demands to assist in the employee's recovery.
Who is required to file transitional modified duty agreement?
Employers are required to file transitional modified duty agreements for injured employees.
How to fill out transitional modified duty agreement?
To fill out a transitional modified duty agreement, the employer must include information about the injured employee, the temporary work assignments, and the expected duration of the modified duties.
What is the purpose of transitional modified duty agreement?
The purpose of transitional modified duty agreement is to facilitate the injured employee's recovery by providing alternative work assignments that accommodate their physical limitations.
What information must be reported on transitional modified duty agreement?
The transitional modified duty agreement must include details about the injured employee, the nature of the injury, the modified work assignments, and the expected duration of the transitional period.
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