July 31, 2017
Keys to Injury Management: An Employer’s Guide to Modified Work in BC Accommodations
This guide describes the key components of a modified work program that will help get injured employees back to work in a safe and timely manner.
Customizable Forms and Templates
- Form A: Early and Safe Return-to-Work Letter to Employee
- Form A (alt): Employee Injury Management/Return-to-Work Checklist
- Form B1: Letter to Physician
- Form B2: Letter to Physician – Modified Work
- Form C: Physician Assessment – Stay-at-Work/Return-to-Work Planning
- Form D: Modified Work Offer
- Form E: Accident Witness Statement
- Form G: No Time Loss and No Medical Aid – Non-Reportable Incidents
- Form H: Time Loss and Medical Aid Checklist – Reportable Incidents
- Form I: Supervisor’s Communication Log
- Form I (alt): Coordinator’s Communication Log
- Form J: Graduated Return-to-Work Plan
- Form K: List of Modified Work
- Form L: Employee Orientation Checklist
WorkSafeBC Forms
- Form 55B23: First Aid Record
- Form 6: Application for Compensation and Report of Injury or Occupational Disease
- Form 6 Reference Guide
- Form 7: Employer’s Report of Injury or Occupational Disease
- Form 7 Reference Guide
- Form 8/11: Physicians’ Report
- Form 8/11 Addendum: Practitioner’s Report – Additional Information
- Form 9: Employer’s Statement of Return to Work
- Form 63M4: WorkSafeBC Authorization of Representative
