2. Table of Contents
Part 1: Return to Work Plan .................................................................................................. 3
MEMO ........................................................................................................................................... 3
Return to Work Checklist.............................................................................................................. 3
Communication Method ................................................................................................................ 3
Schedule ......................................................................................................................................... 4
Physical Requirements................................................................................................................... 4
Responsibilities............................................................................................................................... 4
Alternate, Modified and Transitional Duty.................................................................................... 5
Physical Limitations....................................................................................................................... 5
Job sharing..................................................................................................................................... 5
Re-assessment................................................................................................................................. 6
Part 2: Communication with the stakeholders ........................................................................ 7
Attending Physician ....................................................................................................................... 7
Employee........................................................................................................................................ 8
Email to Operations Supervisor..................................................................................................... 9
References ............................................................................................................................10
Appendix A ...........................................................................................................................11
3. Part 1: Return to Work Plan
MEMO
TO: All Stakeholders
FROM: Ruth L. Pialan - Case Manager
SUBJECT: Return-To-Work Plan
DATE: October 23, 2022
CC: Charles Dickens - VP for Operations, Valerie Baez - Operations Supervisor
Savers Depot as an employer gives paramount importance to workers' safety and health. It is of
utmost importance to the company to ensure injured workers recover safely and return to work
quickly as possible. In order for a smooth transition between the injured worker, supervisors,
other stakeholders and co-workers, the policies are in place (BC Retailers, n.d.).
Return to Work Checklist
Physician letter Employee Restrictions
Acknowledgment
Form 6
Functional Ability
Assessment
Supervisor Restrictions
Confirmation
Form 7
Bi-monthly
Assessment Report
Schedule Log Form 8
Communication Method
A clear open communication with the case manager, an injured employee, the attending physician,
the supervisor and Work Safe BC. The most convenient form of communication shall be by a
phone call to the injured worker on the agreement of the date to work. An email from the attending
physician or caregiver with the corresponding letter and functional ability assessment report to
4. determine the limitations. Notice shall be provided to the supervisor for the schedule, date and
duties with the related rules to accommodate the injured worker (Kelloway, 2021).
Schedule
Harpreet's work hours are reduced as recommended by the physician working five hours daily,
taking additional breaks and sharing their job with a part-time or temporary employee.
As per the physician's recommendation, Harpreet may return to work starting November 1, 2022,
for a maximum of five hours daily.
Physical Requirements
The injured employee workstation is modified by providing material handling aids, adjustment of
height and reaches distances, assembly fixtures, power tools, ergonomically designed tools, and
modification to a sitting workstation. These workstation modifications can reduce injuries and
improve employee productivity (BC Retailers, n.d).
Responsibilities
Injured Employee
• Inform the case manager, supervisor, or attending physician when medical attention is
needed.
• Perform duties according to the agreed restrictions
• Follow the protocols for health and safety
• Follow the physician’s directives, never working beyond medical restrictions.
Supervisor
• Inform all employees in the department about the return-to-work plan
• Provide assistance and support on the physical arrangement, scheduling, and transitional
duties provided in the medical restrictions
• Foster a welcoming work environment together with the other employees to the injured
worker
• Provide transitional duties and progression of activity to the injured worker
• Make an assessment report every two weeks to record development and improvement
5. Case Manager
• Monitor the injured worker regularly
• Assessment of the development and improvement of the conditions
• Coordinate with the physician for the progress of the condition
Alternate, Modified and Transitional Duty
To ensure complete recovery, the injured worker who will return to work shall provide an
alternative, modified and transitional duties based on the weekly assessment.
• A graduated number of working hours daily as advised by the physician for the next two
week
• The physician's recommendation on the graded activity and limitations must be followed
strictly.
The regular job of the injured employee is modified to meet physicians' restrictions (Work Safe
BC, 2022).
Physical Limitations
• Sedentary Work
I occasionally lift 10 kilos maximum, with frequent lifting and carrying of lighter objects such as
file folders, laptop computers and small tools. Although a sedentary job is generally considered
one which involves sitting, a certain amount of walking and standing is often necessary for carrying
out job duties.
• Employee may use hand(s) for repetitive: Single grasping, pushing and pulling; and fine
manipulation.
• Employees may use foot/feet for repetitive movement as in operating foot controls.
• Employee may bend, twist, squat, climb, reach
Job sharing
Some tasks that exceed restrictions are shared with other employees
• The employee is paired with another employee, with functions that exceed limitations
performed (or assisted) by the non-injured employee
6. • Entire jobs are rotated among employees, reducing the time the injured employee spends
doing more strenuous tasks (assuming this period is within the employee’s restrictions).
The above restrictions are in effect until December 31, 2022, or until the employee is re-evaluated
on December 1, 2022.
Re-assessment
Every two weeks, upon return to work, the supervisor shall assess the improvement of the injured
workers' daily duties. A re-assessment report must comply together with the observation and
recommendations. The information shall be endorsed to the attending physician to provide
physical limitations, adjustment to activities, or complete removal of the restrictions. The attending
physician shall provide the final assessment and recommendations based on the reports made by
the supervisor and case manager with the corresponding activity logs.
7. Part 2: Communication with the stakeholders
Attending Physician
October 23, 2022
Dr. John Doe
Icare Workers Clinic
Unit 6, Civil Plaza, Surrey, BC, V3R 4T2
RE: Return-to-work program
Dear Dr. Doe:
As an employer, the safety and health of my workers are of the utmost importance. I understand
that Harpreet cannot attend work due to an accident on duty. Thank you for listening to her
needs.
Savers Depot is committed to helping any of our workers who have been injured on or off the job
to return to work as soon as possible.
We have implemented a return-to-work program, and this is designed to bring employees back to
work as soon as they are physically able to perform comfortable work without aggravating their
injury or illness.
Please complete the attached “Attending physician’s report: Return-to-work recommendations”
form and email it to me at ruthpialan@saverdepot.com.
If you have questions, please call me at +123456789.
Sincerely,
Ruth L. Pialan
RTW Case Manager
(BC Retailers, n.d.)
8. Employee
October 23, 2022
Harpreet Singh
15023 St.
Surrey, BC, V2R 5T2
Dear Harpreet:
Your attending physician, Dr. Doe, has released you to return to work transitional duties, and
there is work available that falls within your restrictions.
Please report to Valerie Baez, your Supervisor, on November 1, 2022, at 8:00 AM.
Everyone is looking forward to seeing you back at work.
If you have any questions, please call me at +123456789.
Sincerely,
Ruth L. Pialan
Case Manager
(BC Retailers, n.d.)
9. Email to Operations Supervisor
To: Valerie Baez, Supervisor - Operations
CC: Jane Crawford, HR Director
From: Ruth L. Pialan, RTW Case Manager
Subject: Return To Work Plan - Harpreet
Hi Valerie,
Good day. I hope this email finds you well.
As we all know, Savers Depot is committed to helping any of our workers who have been injured
on or off the job to return to work as soon as possible. With this, I request your utmost support and
collaboration on this return-to-work plan for Harpreet.
According to the attending physician's recommendation, Dr. John Doe, we will implement the
return-to-work program to bring Harpreet back to work on November 1, 2022. Dr. Doe provided
the following restrictions and guidelines to follow:
• Maximum number of hours worked: 5 hours (excluding lunch breaks)
Limitations:
• Walking tasks - 15 minutes every two hours
• Standing tasks - 45 minutes every hour
• Hand usage - repetitive hand grasping, pulling and pushing
• Hand lifting - maximum of ten kilos in two times average per hour
Please send the attached “Return-to-work Checklist” forms and email them to me at
ruthpialan@saverdepot.com.
To assist you further, attached is the memo for the return-to-work plan.
If you have questions, please call me at +123456789.
Sincerely,
Ruth L. Pialan
RTW Case Manager
10. References
BC Retailers. (n.d.) Back to Work, Back to Health. https://www.worksafebc.com/en
Kelloway, K., Francis, L., Gatien, B., & Belcourt, M. (2021). Management of Occupational
Health and Safety. Nelson Series in Human Resources Management.
Work Safe BC. (2022). Occupational Health and Safety Regulation.
https://www.worksafebc.com/en/law-policy/occupational-health-safety/searchable-ohs-
regulation/workers-compensation-act/part-2-occupational-health-and-
safety#SectionNumber:Part2Div4Sec21
