Employee Back To Work Form Template for Canada

1. Gradual Return Schedule: Used when employee requires a phased return to work, detailing progressive increase in hours/duties

2. Modified Duties Description: Used when temporary or permanent modifications to job duties are required

3. Medical Treatment Schedule: Used when ongoing medical appointments or treatments need to be accommodated

4. Workers' Compensation Information: Used for cases involving workplace injuries and WCB claims

5. Follow-up Plan: Used when regular monitoring and assessment of the return to work plan is needed

6. Emergency Response Plan: Used when employee has specific medical conditions requiring emergency protocols

1. Schedule A - Functional Abilities Form: Detailed medical provider's assessment of employee's capabilities and limitations

2. Schedule B - Workplace Modification Checklist: List of required workplace modifications and their implementation status

3. Schedule C - Progressive Return Schedule: Detailed timeline for gradual increase in hours or duties

4. Schedule D - Job Duties Checklist: Comprehensive list of regular job duties marked as approved/restricted

5. Appendix 1 - Employee Rights and Responsibilities: Document outlining employee's rights and responsibilities during return to work

6. Appendix 2 - Employer Accommodation Policy: Copy of relevant workplace accommodation policies and procedures