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RETURN TO WORK PROGRAM Important: Please email or fax completed form to the designated RTW contact on your HR Services Team. Return to Work Referral Form Initial Update Employee Information Name:
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How to fill out return to work referral

How to fill out return to work referral
01
Gather all necessary information, such as the employee's name, contact details, job title, and date of the referral.
02
Identify the reason for the referral, whether it is due to an injury, illness, or other medical condition.
03
Ensure you have the necessary documents, such as medical reports or clearances, to support the referral.
04
Complete the referral form provided by your organization or employer, and ensure that all fields are accurately filled out.
05
Include any additional details or specific instructions that may be required for the employee's return to work.
06
Submit the completed referral form to the appropriate department or individual responsible for handling return to work referrals.
07
Follow up with any additional documentation or information that may be requested by the responsible party.
08
Keep a copy of the completed referral form for your records.
09
Monitor the employee's progress and provide any necessary support or accommodations during their return to work process.
Who needs return to work referral?
01
Employees who have been on medical leave due to illness, injury, or a medical condition.
02
Employees who have received medical clearance to return to work after an extended absence.
03
Employers or organizations with policies or procedures in place that require a return to work referral for employees.
04
Workers' compensation cases where a return to work referral is necessary to document the employee's readiness to resume job duties.
05
Individuals who have undergone rehabilitation or therapy and are now ready to rejoin the workforce with appropriate accommodations.
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What is return to work referral?
Return to work referral is a process where an injured or ill employee is referred back to work by a healthcare provider.
Who is required to file return to work referral?
The employer is generally responsible for filing the return to work referral.
How to fill out return to work referral?
To fill out a return to work referral, the employer must provide details about the employee's medical condition and any work restrictions.
What is the purpose of return to work referral?
The purpose of return to work referral is to facilitate the employee's safe return to work while taking into consideration any medical restrictions.
What information must be reported on return to work referral?
The return to work referral should include details about the employee's medical condition, any work restrictions, and the recommended accommodations.
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