1. Medical Clearance Reference: Include when return to work follows medical leave and requires doctor's approval

2. Phased Return Schedule: Include when the employee will return through a gradual build-up of hours or duties

3. Special Equipment Requirements: Include when specific workplace adaptations or equipment are needed

4. Training/Reorientation Plan: Include when the employee requires refresher training or new skill development

5. Performance Expectations: Include when modified performance metrics or goals need to be established

1. Schedule A: Phased Return Timeline: Detailed week-by-week schedule of increasing hours or responsibilities

2. Schedule B: Workplace Modifications: Specific list of workplace adjustments and equipment to be provided

3. Schedule C: Medical Restrictions: Summary of relevant work restrictions provided by medical professional

4. Appendix 1: Return to Work Checklist: Checklist for both employer and employee to ensure all necessary steps are completed

5. Appendix 2: Contact Information: List of relevant contact persons (HR, supervisor, occupational health provider)