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MODIFIED DUTY/ACCOMMODATED DUTY STATEMENTDate:, you are to return to work on employees Name Return Date modified duty/accommodated duty. This is to inform you that there is a Ninety (90) day limit
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How to fill out modified dutyaccommodated duty statement

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How to fill out modified dutyaccommodated duty statement

01
Start by providing your personal details, such as your name, address, and contact information.
02
Specify the date when the modified duty/accommodated duty statement is being filled out.
03
Describe the specific job duties or tasks that have been modified or accommodated due to your condition or injury.
04
Clearly mention the reasons or medical condition that necessitated the modified duty or accommodation.
05
Include any supporting medical documents, such as doctor's notes or medical reports, if required.
06
Indicate the estimated duration for which the modified duty or accommodation is expected.
07
Provide any additional information or instructions if necessary.
08
Review the statement for accuracy and completeness before submitting it.
09
Sign and date the statement to certify its authenticity.
10
Keep a copy of the filled out modified duty/accommodated duty statement for your records.

Who needs modified dutyaccommodated duty statement?

01
Employees who have experienced a medical condition, illness, or injury that affects their ability to perform their regular job duties may need a modified duty/accommodated duty statement.
02
Employers may also require employees to fill out this statement if they have made modifications or accommodations to an employee's job tasks.
03
Additionally, healthcare professionals or doctors may request a modified duty/accommodated duty statement to document the necessary changes or accommodations for their patients.

What is MODIFIED DUTY/ACCOMMODATED DUTY STATEMENT - ehs mst Form?

The MODIFIED DUTY/ACCOMMODATED DUTY STATEMENT - ehs mst is a fillable form in MS Word extension that should be submitted to the specific address in order to provide certain info. It must be filled-out and signed, which may be done manually, or via a particular solution such as PDFfiller. It allows to complete any PDF or Word document directly from your browser (no software requred), customize it depending on your needs and put a legally-binding e-signature. Right after completion, user can easily send the MODIFIED DUTY/ACCOMMODATED DUTY STATEMENT - ehs mst to the relevant person, or multiple ones via email or fax. The editable template is printable as well from PDFfiller feature and options proposed for printing out adjustment. In both electronic and physical appearance, your form should have a organized and professional appearance. You can also turn it into a template for further use, so you don't need to create a new document again. All you need to do is to customize the ready form.

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Modified dutyaccommodated duty statement is a form filled out by an employer when an employee is unable to perform their regular job duties, and alternative or modified tasks are provided to accommodate their needs.
Employers are required to file modified dutyaccommodated duty statement for employees who require accommodations due to medical restrictions or limitations.
Employers must provide details of the alternative or modified duties assigned to the employee, along with the reason for the accommodations and any medical documentation supporting the need for the modifications.
The purpose of the modified dutyaccommodated duty statement is to ensure that employees receive appropriate accommodations in the workplace to support their medical needs and facilitate their return to work.
The modified dutyaccommodated duty statement must include the employee's name, the accommodations provided, the duration of the modifications, and any medical documentation or recommendations supporting the need for the accommodations.
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