Back To Work Form Template for Canada

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Key Requirements PROMPT example:

Back To Work Form

I need a Back to Work Form for an employee returning from a 3-month medical leave on March 15, 2025, with requirements for modified duties including reduced lifting and shorter shifts for the first month.

Document background
The Back to Work Form is an essential document used across Canadian workplaces to manage and document the process of employees returning to work after an absence. This form is particularly crucial in contexts where employees have been absent due to illness, injury, disability, or other medical conditions. It serves multiple purposes: documenting medical clearance for return to work, specifying any work restrictions or required accommodations, outlining graduated return-to-work schedules if applicable, and ensuring compliance with relevant Canadian federal and provincial legislation including the Canada Labour Code, human rights legislation, and workplace safety regulations. The form helps protect both employer and employee interests while facilitating a safe and appropriate return to work process.
Suggested Sections

1. Employee Information: Basic details including employee name, ID, position, department, and contact information

2. Absence Information: Details about the absence period, reason for absence (if appropriate to disclose), and last day worked

3. Return to Work Details: Planned return date, whether return is full or modified duty, schedule of return (gradual or immediate)

4. Medical Clearance: Confirmation from healthcare provider that employee is fit to return to work

5. Work Restrictions and Accommodations: Clear outline of any medical restrictions, required workplace accommodations, and duration of these requirements

6. Signatures and Acknowledgments: Space for employee, employer representative, and healthcare provider signatures, including date

Optional Sections

1. Workplace Injury Details: Required only if absence was due to workplace injury - includes WCB/WSIB claim number and incident details

2. Graduated Return to Work Schedule: Detailed weekly schedule for cases requiring gradual return to full duties

3. Follow-up Appointment Schedule: Details of required follow-up medical appointments or assessments

4. Accommodation Cost Details: Breakdown of costs associated with required workplace accommodations, if applicable

5. Union Representative Acknowledgment: Additional signature section for unionized workplaces

Suggested Schedules

1. Physical Demands Assessment: Detailed analysis of job physical requirements and employee's current capabilities

2. Medical Assessment Form: Healthcare provider's detailed evaluation of employee's fitness for work

3. Workplace Modification Checklist: List of required workplace modifications or accommodations

4. Follow-up Meeting Schedule: Timeline for check-in meetings to monitor return to work progress

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions
Relevant Industries

Healthcare

Manufacturing

Construction

Retail

Financial Services

Technology

Education

Public Sector

Transportation

Mining

Hospitality

Professional Services

Energy

Agriculture

Telecommunications

Relevant Teams

Human Resources

Occupational Health and Safety

Legal

Employee Relations

Risk Management

Benefits Administration

Disability Management

Compliance

Operations

Relevant Roles

Human Resources Manager

Occupational Health and Safety Specialist

Return to Work Coordinator

HR Business Partner

Benefits Administrator

Employee Relations Manager

Disability Management Specialist

Health and Safety Officer

HR Director

Risk Management Specialist

Workers' Compensation Coordinator

Personnel Manager

HR Compliance Specialist

Industries
Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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