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MODIFIED DUTY FORM TO BE COMPLETED BY HEALTHCARE PROVIDER ONLY if there has been a change in patients abilities. WRHA will pay up to $25.00 for the COMPLETED form. Completed forms can be faxed to
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01
Obtain the modified duty form from your HR or safety department.
02
Fill in your personal information, including name, department, and position.
03
Describe the nature of your injury or condition that requires modified duty.
04
Indicate any physical limitations or restrictions you may have.
05
Specify the type of modified duties you are able to perform.
06
Provide a suggested duration for the modified duty arrangement.
07
Have your supervisor review and sign the form.
08
Submit the completed form to HR for approval.

Who needs modified duty formwrha professionals?

01
Employees recovering from injuries or medical conditions requiring temporary adjustments to their job responsibilities.
02
Employers looking to support their workforce by accommodating employees' needs during recovery.
03
Human resources professionals managing employee health and safety adjustments.
04
Health care providers recommending modified duties for their patients returning to work.
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The modified duty form for WRHA (Winnipeg Regional Health Authority) professionals is a document used to manage the return-to-work process for employees who are recovering from an injury or illness, allowing them to perform modified duties suitable for their current capabilities.
Employees who are returning to work after an injury or illness and are capable of performing modified duties are required to file the modified duty form with their employer.
To fill out the modified duty form, employees must provide personal details, describe their injury or illness, outline their capability for modified work, and include any proposed modified duties as recommended by their healthcare provider.
The purpose of the modified duty form is to facilitate a safe, supportive, and gradual return to work for employees while they continue to recover from their injuries or illnesses.
The form must include employee details, description of the injury or illness, medical recommendations, proposed modified duties, and the expected duration of modified work.
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