Plan an employee’s return after leave or injury: date, any restrictions, schedule and a check-in.
A planned return helps the employee and the team: the schedule is ready, duties are clear and any restrictions are respected.
After a workplace injury, workers’ compensation rules may apply. Disability laws may also require you to consider reasonable accommodations. Get advice when restrictions are involved.
15 items. Fill it in on screen or print a copy.
A delivery driver returns after a knee injury with a two-week restriction on lifting over a set weight. He is assigned dispatch support for two weeks and returns to routes after the review.
A written return plan shows the employer received the provider’s restrictions and assigned work within them, which lowers the risk of re-injury and supports workers’ compensation and disability accommodation obligations. The fixed review date prevents temporary restrictions from drifting into a permanent, undocumented change.
| Employee and role | Marcus, stocker, Hilltop Grocery, Spokane |
|---|---|
| Absence category | Work injury, workers’ comp claim |
| Return date | October 6, partial return |
| Restrictions | No lifting over 20 lb for 3 weeks |
| Duties adjusted | Price checks, shelf facing, front-end bagging |
| Hours first weeks | 6-hour shifts, weekdays only |
| Review date | October 27 |
Restrictions are recorded exactly as the provider wrote them, and the duties listed are ones the store already has, so nothing is invented just to fill time.
Policies vary; follow the law and your policy.
Discuss accommodations; get advice.
A short meeting helps a lot.
In the personnel file; medical documents separately.
Generally you should ask only for what you need to plan the return, such as the date and any work restrictions from the provider. The Americans with Disabilities Act limits medical inquiries to those that are job-related and consistent with business necessity. Keep any medical documents in a separate confidential file, not with this form.
Light duty is a temporary set of tasks that fit within someone’s restrictions, such as desk or dispatch work instead of lifting. Whether you must offer it depends on your policy, workers’ compensation rules and, for some conditions, ADA accommodation duties. Record the adjusted duties and the review date on the form so the temporary arrangement has a clear end.
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Employees can fill in and sign forms like this in the EZTime app, and the signed copy lands in their digital employee file. Book a demo if you want a walkthrough.