RTW Forms and Templates for Employers

RTW Forms and Templates for Employers

When an injury occurs it can be a difficult and confusing time for everybody involved. To help you prepare, you can print the necessary forms in advance and have them packaged along with instructions to make the RTW process easier.

Forms

Employer's Report of Incident

Templates

Injured Worker Example Scenario
Procedure Development Advice
Procedures outline the who, what, when, and how questions for each step in the process.
Prompts for Identifying Suitable Work
The following prompts may help you in thinking of alternative work that is of value to the organization. Remember, if... more
Return to Work Program Checklist
Use this checklist to ensure that your RTW program has the minimum requirements.
Sample Checklist for Managing Return to Work
Note: The checklist may alter depending upon your organization’s procedures.
Sample Communications Log
Sample Job Demands Summary (1)
Sample Job Demands Summary (2)
Sample Letter to Health Care Provider
Note: This is a sample letter only
Sample Return to Work Plan
Sample Return to Work Plan Closure Evaluation
The intent of this evaluation form is to help the organization improve future RTW plans and the RTW program.
Sample Return to Work Plan Monitoring Form
Employers and workers, use this form to assist in tracking progress throughout the RTW plan.
Sample Return to Work Policy
Note: This is a sample letter only.