Forms
Form L: Employee Orientation Checklist
This checklist describes what a supervisor needs to tell employees about the RTW program.
Form J: Graduated Return to Work Plan
This form is for documenting an RTW plan to get an injured employee back to regular duties.
Form I (alt): Coordinator’s Communication Log
This alternative Form I is for coordinator communication with injured employees regarding the injury management process.
Form I: Supervisor’s Communication Log
This form is for documenting communications with injured employees regarding return to work planning.
Form G: No Time Loss and No Medical Aid Checklist – Non-Reportable Incidents (Accommodation)
This checklist describes steps to follow for incidents that don’t require care from a health-care provider or time away from work.
Form A (alt): Employee Injury Management/Return to Work Checklist
This alternative Form A describes an injured employee’s responsibilities under the company’s RTW program.
Form A: Early and Safe Return to Work Letter to Employee
This is a letter for the employer to send to an injured employee. It explains that there is an injury management/RTW program and modified work is available. It also describes which forms the employee should bring to their physician.
Form K: Employee Orientation Checklist for Return-to-Work Programs
This checklist describes what a supervisor needs to tell employees about the RTW program.
Form J: Modified Work List
This form describes how a modified work list should be developed and includes a sample list for food and beverage operations.
Form I: Return to Work Plan
This form is for documenting an RTW plan to get an injured employee back to regular duties.