Return to Work
WorkSafeBC Form 9: Employers Statement of Return to Work
This official WorkSafeBC form is for physicians to use when workers come to them with an injury or occupational disease.
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 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 G: Time Loss and Medical Aid Checklist (Reportable Incidents)
This checklist describes steps to follow for incidents that require care from a health-care provider or time away from work.
Form F: No Time Loss and No Medical Aid Checklist (Non-Reportable Incidents)
This checklist describes steps to follow for incidents that don’t require care from a health-care provider or time away from work.
Form E: Accident Witness Statement
This form is for witnesses to describe details of injuries and other incidents.
Form D: Modified Work Offer (Food and Beverage)
This form describes the details of modified work being offered to an injured employee.
Form C: Physician Assessment – Return-to-Work Planning
Physicians can use this form to describe an injured employee’s physical capacity and work restrictions.
Form A (Alt): Employee Return to Work Checklist
This alternative Form A describes an injured employee’s responsibilities under the company’s RTW program.