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Modified Duty Agreement/Transitional Work Agreement SMU Office of Risk Management 214.768.2807 fax: 214.768.4138 www.smu.edu/riskmgmt I have been advised by my doctor that my physical activities at

How to fill out modified duty agreementtransitional work

How to fill out modified duty agreement/transitional work:

1. Obtain the necessary forms: Start by obtaining the modified duty agreement/transitional work form from your employer or HR department. This form typically outlines the specific details and requirements for the agreement.
2. Provide personal information: Fill in your personal information accurately, including your name, employee or identification number, contact information, and the date.
3. Specify the medical condition: Indicate the specific medical condition or injury that has led to your need for modified duty or transitional work. Provide any necessary supporting documentation or medical forms as required.
4. Describe work restrictions: Clearly outline the work restrictions that have been prescribed by your healthcare provider. Include any limitations on physical activities, weight lifting, or specific movements.
5. State the duration of work restrictions: Specify the expected duration of these work restrictions. This may be indicated by a specific end date, a target return-to-work date, or a timeframe provided by your medical professional.
6. Identify transitional work options: Discuss potential transitional work options with your employer. This could involve adjusting your current job duties to accommodate your restrictions, transferring to a different department temporarily, or taking on alternative tasks.
7. Agree to responsibilities: Acknowledge your responsibilities as an employee who is participating in modified duty or transitional work. This may include attending all medical appointments, complying with treatment plans, reporting any changes in your condition, and following workplace safety guidelines.
8. Obtain supervisor/employer signature: Once you have completed the form, ensure your employer or supervisor reviews and signs it. This demonstrates their understanding and endorsement of the agreement.

Who needs modified duty agreement/transitional work?

1. Employees with work-related injuries: Those who have sustained work-related injuries and are transitioning back to work may require a modified duty agreement/transitional work plan. These arrangements help facilitate a safe and gradual return to full work duties.
2. Individuals with medical conditions: Employees who have ongoing medical conditions or disabilities may require modified duty or transitional work arrangements to accommodate their limitations. This allows them to continue contributing to the workforce while ensuring their health and safety.
3. Individuals recovering from surgeries: After certain surgeries or medical procedures, individuals may need to gradually reintegrate into the workforce. Modified duty or transitional work agreements assist in facilitating this process by providing tasks that align with their recovery limitations.
4. Pregnant employees: Pregnant employees who require temporary adjustments to their work duties due to safety concerns or physical limitations may benefit from a modified duty agreement/transitional work plan. This ensures their well-being and the well-being of their unborn child.
5. Employees with temporary disabilities: Individuals who experience temporary disabilities, such as a broken bone or a sprained joint, may require modified duty or transitional work options until they have fully recovered.

Remember, it is important to consult with your employer, HR department, or legal advisor to ensure you are following the proper protocols and meeting the specific requirements of your workplace.

For pdfFiller’s FAQs

What is modified duty agreement/transitional work?

Modified duty agreement/transitional work is a temporary work arrangement designed to accommodate an employee who is unable to perform their regular job duties due to injury or illness. It involves adjusting tasks or providing alternative work to aid in the employee's recovery.

Who is required to file modified duty agreement/transitional work?

Employers are typically responsible for creating and implementing modified duty agreements/transitional work plans for injured or ill employees.

How to fill out modified duty agreement/transitional work?

To fill out a modified duty agreement/transitional work, the employer must outline the specific job tasks or accommodations that will be provided to the employee, as well as the expected duration of the modified work arrangement.

What is the purpose of modified duty agreement/transitional work?

The purpose of modified duty agreement/transitional work is to facilitate the employee's return to work in a safe and timely manner while they recover from an injury or illness.

What information must be reported on modified duty agreement/transitional work?

The modified duty agreement/transitional work must include details of the employee's restrictions, the modified job duties or accommodations provided, the start and end dates of the transitional work period, and any other relevant information related to the employee's recovery plan.

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