Light Duty For Work

State:
Multi-State
Control #:
US-189EM
Format:
Word; 
Rich Text
Instant download

Description

The Light Duty Assignment Request Form is designed for employees seeking modified work responsibilities due to an injury or medical condition. This form allows the employee to formally request light duty status, which may be granted on a trial basis for one month, subject to evaluation by their supervisor and the Human Resources Department. Key features of the form include sections for the employee’s personal information, job title, details about their injury, and the specific duties they can perform while on light duty. Users must indicate whether a light duty assignment is available within their department and specify the duration of the assignment. This form supports critical communication between the employee, supervisor, and HR, ensuring clarity regarding job modifications. It serves as an essential tool for attorneys, partners, owners, associates, paralegals, and legal assistants, facilitating compliance with workplace injury management protocols and legal requirements. Accurate completion of the form aids in streamlining the accommodation process, benefitting both the employee and the employer.

How to fill out Light Duty Assignment Request?

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FAQ

Light duty is less demanding work, physically and/or mentally. An example would be answering phones instead of stocking shelves. Modified duty means work in which obstacles that prevent injured workers from carrying out their essential job duties are changed, adapted, or eliminated.

Five common examples include: the worker's old job, but without any strenuous duties, a desk job, taking inventory, working as a parking attendant, or. handling customer service calls.

This letter introduces you to the physician and informs him or her that your company is willing to offer light duty work to the injured worker. The letter requests that the doctor provide you with the employee's up-to-date work restrictions.

________________ Dear [employee]: This memorandum is to confirm that we will temporarily accommodate your physical restrictions by modifying your regular job of ________________. Your health care provider has approved you to return to modified duties, as outlined in the attached medical report, dated ________.

RTW programs include temporary light-, limited- and modified-duty assignments. Light duty typically involves excusing an employee from performing certain tasks that he or she would normally perform. Limited duty may reduce the number of hours that someone normally works in a day.

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Light Duty For Work