<ADD COMPANY LETTERHEAD OR LOGO>

Date

<EMPLOYEE NAME>

<EMPLOYEE STREET ADDRESS>

<EMPLOYEE CITY, STATE, ZIP>

RE: Light duty Assignment

Dear <EMPLOYEE>:

We value you as an employee and would like you to return to work with us as soon as possible.

Information received from Dr. <DOCTOR’S NAME> indicates you are able to return to work provided you do not perform activities outside of those recommended. Please see the attached return-to-work fitness for duty status and physician certification form <RETURN-TO-WORK RESTRICTIONS>.

After carefully considering your current restrictions, we have developed a temporary position which will allow you to return to work in a light duty capacity while you continue to recover. We are committed to working with you and your doctor to ensure your current condition is not aggravated by this temporary position which will entail <LIGHT DUTIES (be as specific as possible)>. Your hourly rate will be $<HOURLY RATE>.

We request that you report to <SUPERVISOR’S NAME> on <DATE OF RETURN>. At that time your work assignment, scheduling and pay will be explained. Any wage differential will be compensated by our insurance carrier.

If you have any questions or concerns, please feel free to contact me by telephone at <TELEPHONE NUMBER> within 24 hours of receipt of this letter. Failure to report to work could jeopardize your right to further workers compensation benefits. We look forward to your return to work.

Sincerely,

<SENDER’S NAME AND TITLE>

cc:	Manager/supervisor

Insurance carrier claims adjuster

Corporate claims manager

Employee’s attorney (if applicable)

Note: Regular and certified return receipt requested.