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

Checklist for Managing Return to Work
Note: The checklist may alter depending upon your organization’s procedures.
Communications Log
Job Demands Summary
Letter to Health Care Provider
Note: This is a sample letter only
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 Plan
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.
Return to Work Plan Monitoring Form
Employers and workers, use this form to assist in tracking progress throughout the RTW plan.
Return to Work Policy
Note: This is a sample letter only.
Return to Work Procedure Development
Effective RTW procedures should be specific to the unique needs of your organization. You must communicate them to all... more
Return to Work Program Checklist
Use this checklist to ensure that your RTW program has the minimum requirements.