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RE: Light Duty
Dear
[[formData.mrMs]]
,
This will confirm our discussion today.
has been able to identify an opportunity for you to work within your
restrictions as a Staff Assistant in a temporary transitional assignment. In addition, the company will give back to the community by donating your time to a nonprofit organization.
This will confirm our discussion today.
has been able to identify an opportunity for you to work within your
restrictions as a Staff Assistant in a temporary transitional assignment. In addition, the company will give back to the community by donating your time to a nonprofit organization. As an employee in the state of Oregon, you have the right to refuse this offer to return to work without repercussions; participation in the off-site light work program is voluntary.
This will confirm our discussion today. We have been notified that your physician, Dr.
has released you to return
to work with physical restrictions as of
.
has been able to identify an opportunity
for you to work within your restrictions as a Staff Assistant in a temporary transitional assignment. In addition, the company will give back to the community by donating your time to a nonprofit organization.
This will confirm our discussion today. We have been notified that your physician, Dr.
has released you to return
to work. We are in receipt of the DWC-73 dated
(attached) outlining the restrictions under which you are able to return to work. Pursuant
to Texas Workers’ Compensation Commission Rule 129.6, this letter is a Bona Fide Job Offer for you to return to work within your restrictions, as a Staff Assistant at a local nonprofit organization (NPO) for a temporary, modified duty assignment. In addition, the company will give back to the community by donating your time to a local charity.
You will participate in a light duty opportunity from your home. This assignment is scheduled to begin on
.
You will be provided with the materials required to be successful in this assignment, as well as training from the nonprofit organization on your assigned tasks. You
will be supporting the
mission.
You will be loaned the equipment necessary to complete your assigned tasks, including a tablet with protective case, headset, mouse, and keyboard. It is expected that you treat this valuable equipment with care and return per provided instructions in the condition that it was received at the conclusion of your assignment. Should this equipment not be returned within fourteen days of completing your assignment, you may be billed for these materials.
You will be reporting to a Charity Supervisor,
.
Your work schedule will be
Your hours worked will
be logged via your provided electronic tablet. Both you and your Charity Supervisor will review and electronically sign the timesheet. Once signed by both parties, it will be submitted for processing to payroll.
In addition, you will be working with
,
your Transitional Work Solutions Coordinator.
[[coordinatorName]] will be available to you at
should you have questions about the materials provided to you for your assignment.
Your Job duties in this transitional work will include:
This work all
falls within your
work restrictions of:
,
issued by Dr.
[Insert Doctor's Name]
on
[Insert Date of Restrictions].
You will
be properly trained by your Charity Supervisor to perform these duties.
You will be paid
for the time you actually work. Tell your Charity Supervisor in advance when you must leave your temporary
work assignment to attend a doctor’s appointment. Your doctor’s appointments must be logged appropriately daily on your electronic tablet.
You will be paid your regular wages for the time you actually work. Tell your Charity Supervisor and Transitional Work Solutions Coordinator in advance when you must leave your temporary work assignment to attend a doctor’s appointment. Your doctor’s appointments must be logged appropriately daily on your electronic tablet.
Should physical therapy be required, your appointments should be scheduled around your work schedule.
at 3CU can assist you in scheduling any appointments, if needed.
You can reach
at
.
If you are going to be late or will not be coming to work, please email your Charity Supervisor and TWS Coordinator at least one hour in advance of your scheduled shift and provide a reason why you are late or unable to work that day.
You are employed by the company and you are representing [[formData.jobSiteName]] at this site. Thus you must present yourself in a professional manner. All of our work and safety rules apply. You are working for [[formData.jobSiteName]], and you are covered by our workers’ compensation carrier.
We will work with you and your treating doctor to change your job duties as your doctor’s reports illustrate updated restrictions. Your program duration will last until release to work with no restrictions, or restrictions that may be reasonably accommodated by the employer, Maximum Medical Improvement identified, or end of a sixty (60) day calendar period; whichever occurs first. Should you reach the end of 60 days, your assignment will be re-evaluated every thirty (30) days thereafter.
Please contact me at
with any questions.
Very truly,
[[formData.jobSitePhone]]
CC: [[formData.claimsAdjusterName]]
,
Cc: Claimant Attorney:
, Esq.
via email/fax
Program Acceptance/Refusal
I, [[formData.employeeName]], have received and accept the modified duty offer:
Employee Signature _____________________________________________________
I, [[formData.employeeName]], refuse the modified duty assignment:
Employee Signature _____________________________________________________
Date ___________________